Written evidence submitted by Dr Kate Elliott (FGP0103)

 

I am a salaried GP at Adelaide Medical Centre in Andover – one of 6 (4.2 FTE) GPs serving a population of approx. 9,500 patients in a network of 5 practices. I qualified as a GP in 2015 and have 2 children aged 3 and 5. I have worked in a 7 different practices in South East London and Hampshire over my GP training and as a qualified GP.

In response to the questions posed in this evidence gathering on the future of General Practice I have the following comments:

Barriers to access are largely workforce number inadequacy related – this has been universal in the places I have worked. Adding to this I have also observed premises limitations (not enough consulting rooms) and IT/infrastructure system inefficiencies (watching a “busy thinking about it” icon for 2 minutes to view a document, phone line number limits).

The support for General Practice feels like anything but and the framing of the funding, moving much old money around with the strings it has attached, means it feels of little practical value. The portrayal of primary care as lazy by the Health Secretary has been utterly demoralising.

Andover has received additional funding for mental health workers which the network has implemented in a team of social prescribers, health and well-being coaches and mental health practitioners. First access physiotherapists have also been engaged to provide appointments across the network. These services are alleviating the workload on GPs.

I fully support digital access for patients – to book appointments, view results, request prescriptions, attend to administrative tasks and engage in planned care I think it is wonderful. I have reservations around e-consulting as a triage for a new presentation – algorithms are risk averse and are more likely to direct patients to 111/A&E than a clinician. The present system of e-consults with short targets for a GP response is pushing those who are literate and tech savvy to the front of the queue and this is widening health inequalities.

I wholeheartedly believe in a named GP or small team of GP/HCPs working to provide care to a list of patients – where patients and clinicians work together, know each other – there is strong evidence that a system that can provide this improves patient and clinician satisfaction, improves quality of care, reduces unnecessary investigation and treatment.

https://www.rcgp.org.uk/clinical-and-research/our-programmes/innovation/continuity-of-care.aspx

https://www.bmj.com/content/303/6811/1181.short

This kind of system is an ideal breeding ground for initiatives to address public health and implement prevention strategies and I am passionate about this area – leading on prevention initiatives – physical activity and dietary – in the last couple of years. Prevention isn’t however a healthcare provider responsibility – although as a mouthpiece for delivery of health promotion primary care has power, prevention really needs to start before there is a health need and from broader strategies across disciplines – infrastructure, parks, nature and green spaces and, critically I feel, the food industry – we have a nation addicted to sugar and highly processed food from childhood and trying to undo that damage when someone is 45, obese and has diabetes and liver disease is often hugely challenging.

I am fearful of working in a more “hot desk” approach and have tried a type of this consulting remotely for a private provider patients have less confidence in the clinician they consult, more investigation tends to occur and patients are more likely to complain with greater potential for escalation to litigation. I undertook this work for 6 months but left despite good pay because of the burden of repeatedly consulting “new” patients.

GPs per head of population – there is scientific evidence on the ideal number to keep GP skill mix and allow sufficient time to deliver quality care and this around 1500 patients per FTE GP and that for every patient over 2000 quality of care clearly diminishes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3750771/

We are currently working at around 2,200 per FTE across the UK and in some areas this is up to 3000. I personally manage a list of about 1450 patients working as 0.66 FTE. The burden of this workload is why every GP I know works 11-12 hour days and additional hours in their “days off”. The systematic and protracted failure to invest in primary care means it is hard to see the situation improving in the near future. Writing this down – I find it increasingly difficult to see a future for myself working in healthcare in the UK.

 

Dec 2021