Written evidence submitted by Dr Jennie Dock (FGP0105)

 

The biggest challenge for GP at the moment is that demand exceeds supply. Some of this is pandemic induced (increased mental health problems, backlog of secondary care meaning more interventions like pain relief or reassurance needed from GP, covid, long covid, vaccination problems and vaccination queries), but I also feel that patients have become more acopic over the pandemic and have forgotten to self care and lost their tolerance for just putting up with a problem for a few days.

 

Online consultation tools provide a good and safe front door where patients can access them, and do help relieve the pressure on the phones. We currently have unsustainable demand on the phones (in particular in the mornings) but this is because people are having to keep trying to access what they want / need.

 

There is an argument for a payment per consult model, but this brings its own problems, not least bureaucracy.

 

One quick win would be fit notes – allow other healthcare professionals (ANPs, MSK first contact practitioners, clinical pharmacists) to generate them, or ideally, take the whole issue out of General Practice and have a completely separate service for it.

 

The problem around not enough GPs is well known, and the good work around getting ARRS staff into PCNs has gone some way towards this. They do however have too many other things to do in their time – e.g., the clinical pharmacists and the SMRs – I understand these are really good practice, but they detract from actually seeing the patients rather than GPs seeing them.

 

More investment is needed into upskilling HCAs and Practice Nurses – for example, we have an HCA who is really keen to do her nursing degree, but when we looked at the apprenticeship route, it would mean we lost her for chunks (weeks) of time – this isn’t a sustainable model to work with – and it was expensive (with no guarantee that she would stay with us).

 

GP time is precious, and it’s important that they do work that only they can do, so good signposting or triage is key. I am interested to see what AI can do to support this. When a patient does need the expertise of a GP, there are generally two types of consultation: any GP or continuity GP. For an ongoing problem, it is usually better to have the same GP consult with the patient as they will already know the history, will already have a plan, and will already have a relationship with the patient. In a large practice, this isn’t always practical, but it is ideal for the patient and the GP. That doesn’t have to be their “named GP”. In our experience, the patient usually makes the right choice about whether they need continuity or not. And they usually also make the right choice about the mode of consultation: F2F or remote.

 

Challenges facing GP in the next five years include: Shrinking GP and Nurse workforce (early retirement, reduction in working hours, emigration, less new starters); increased demand (less patients using self-help initially, less reliance on family support, people quicker to ask for interventions for minor symptoms); PM burnout (although new people are coming in from outside to replace those leaving, a wealth of experience is being lost) – it is incredibly destabilising for a practice to lose their PM; Partnership working with PCNs – where this works well, it gives great stability and resilience to the practices involved, when it goes wrong it is like being involved in a messy divorce; ageing estates – many practices are in premises that are not fit for purpose or they have outgrown – the estates program was paused for a long time and now needs catching up; Wages – minimum living wage, and the increase in employer pension contributions is set to make a bit dent in cashflow and profitability for GP, this could make many practices unsustainable; and finally the pandemic, whether that is the aftereffects being felt (backlog, long covid, mental health), or ongoing pandemic and the associated vaccine program.

 

You ask what part GP should play in the prevention agenda: GP needs to treat patients holistically, not as a disease. Prevention is part of health and wellness, so yes, GP should be involved in prevention.

 

What can be done to reduce bureaucracy and burnout and improve morale in GP? There are some really easy quick wins: tell us before you tell the media; communicate well with the general public so they know when our hands are tied, or when something isn’t our fault, or our responsibility. One of the most soul-destroying parts for PMs at the moment is complaints, in particular about appointment access. When something like this is a national problem, there needs to be national communication, and good publicity about it. I get a complaint from a patient almost every day saying they can’t get an appointment. We have more capacity than we have ever had, but demand still outstrips supply. I have written information on our website about the pressures, so I won’t repeat them here. Many GPs have reduced their sessions because they are over the pension cap – more resource would help with pressure, and GPs would reduce hours or retire as early if this was addressed. A really key thing would be to involve Practice Management (not just GPs) in planning any changes to General Practice. It’s great to have the clinical view, but for sense checking what problems or additional bureaucracy it will cause, ask a PM. The IGPM (Institute of General Practice Managers) are keen to support here.

 

How can the future model of GP be improved? Yes, Partnership is the right model as it gives ownership, manoeuvrability, fast decision making and ownership of results. But be more open and supportive to non-GP partners. The recent example of the “golden hello” excluding PMs devalued the contribution of PMs. I don’t believe PCNs have reduced the administrative burden, they have increased it – payments are much more complicated, communication is more complicated, planning is more complicated. I think they have on the whole achieved their aim – to reduce the number of small practices, and to even out any extremes. The model of General Practice isn’t broken, so don’t try to fix it – what needs to be attended to is the demanding, instant gratification, entitled attitude increasing numbers of patients have. Above all, keep it free at the point of care and accessible to all prioritised by need.

 

 

Dec 2021