Written evidence submitted by Dr Matthew Litchfield (FGP0124)

I am writing this response in my role as a GP partner and PCN CD.

In my mind the current crisis in GP has been caused for the following reasons;

• Poor workforce planning
• The proportion of funding assigned to primary care has failed to keep up with secondary care.

The UK has an increasingly elderly population. A significant amount of work has been transferred from secondary care to primary care. Healthcare has become more complex – much more can be done for patients. This all comes at a time when the GP workforce has been falling despite political targets to arrest this fall.

Life as a GP has become increasingly tough. Many GPs now work less than 8 sessions a week. Each session however might last 4-7 hours. This work is usually flat out. For many GPs this is not compatible with normal family life and so they are retiring or looking to use their skills elsewhere.

The terms and conditions of GPs needs to be improved to help make GP a desirable career and also retain existing staff.

The tax and pension rules disincentivise GPs from taking on more work. Why would anyone want to work longer hours if it is not going to lead to increase their take home pay?

The tax and pension rules need to be reviewed urgently.

There is a huge amount of time wasted doing administration. Appraisal is a particular example of this. Whilst some sort of discussion is probably helpful, in its present form however it is unnecessarily bureaucratic and time consuming.

The bureaucratic demands of the job need to be reduced.

The partnership model continues to be an extremely efficient way of delivering primary care locally to patients. Whilst I accept the model isn’t perfect, I do feel that improvements could be made to future proof the model. The model relies on a lot of goodwill which would be lost with a salaried model.

The partnership model remains an efficient way of delivering primary care.

Private companies consistently failed to deliver high quality primary care at the funding levels available for GMS practices.

Continuity of care improves the efficiency of primary care, so having a named GP is important. However, it does make sense to have a diverse team within practices to deliver more cost-effective teams.

The PCN DES has provided welcome increased funding to primary care. However, the structure of PCNs adds a layer of bureaucracy which takes GPs away from seeing patients.

Consider investing the current PCN funding directly into practices.

The additional roles funding has helped to recruit extra staff to primary care. Unfortunately, there has been inadequate flexibility to deploy this funding in the way that would have the most impact on the local population. An example would be in my PCN which consists of 2 student general practices. We would love to employ a number of mental health workers to help meet demand. Unfortunately, the DES only allows us to have 1 mental health worker this year and 1 next year. Whatsmore, they have to be employed by the mental health trust which limits how we can use them.

Consider allowing more flexibility in the PCN additional roles funding.

Premises for many practices are now inadequate. Significant investment is required to address this.

The primary care IT infrastructure is dated and unreliable. Work needs to be done to address this. There is an opportunity to improve efficiency.

The nature of the existing GP contract is that demand is potentially unlimited. Secondary care dumps a lot of work on primary care which is time consuming to sort.

A new GP contract is needed to address a lot of the issues raised in this document.

A meaningful solution needs to be found to enforce secondary care to do the work that they are contracted to do.

Dec 2021