Written evidence submitted by Dr Joanna Swallow (FGP0128)

 

 

Insufficient numbers of GP’s.

GP’s are working at a rate of 40 plus patient encounters per day.

The admin burden is immense and harder to quantify.

GP working days are 12 full hours, lunch is eaten at the desk.

Sadly there is little time for planning, team building, meetings, QI or innovation.

 

Complexity and comorbidity are making the workload higher and harder to fit in, patients are living for longer and it is not possible to deal with their multiple issues safely or effectively in 10minutes.

 

Patient expectation of instant access and immediate care for ailments which might honestly have self resolved, had they waited 24hrs is a problem.

 

The 111 system seems to be poorly functioning, with most calls either being directed to call an ambulance, or to consult the GP the next day.

 

I don’t know of any medical professionals who would choose to call 111 for their/their families healthcare needs.

 

Chronic underfunding of General practice has culminated in a system on the brink, Since the pandemic, we have moved to the unsustainable.

The funding again has not followed this increase in demand.

 

 

It is important to prioritise appropriate access for genuine need.

It is not worth prioritising access for minor issues when the service is overwhelmed by this to the detriment of those with serious or persistent issues.

 

 

It has been proven to reduce hospital admission, and improve patient and doctor satisfaction.

One issue is that the volume of work and the pressure means that there are very few GP’s who work full time.

The profession has been degraded by the intensity and most GP’s now, particularly the newly qualified/younger professionals are choosing to have portfolio careers (for a variety of reasons but largely) to lighten their working intensity from practice.

 

This makes continuity hard to achieve.

 

 

A practice job share model with a shared WTE list.

 

Protected day time working, with a cap on the number of patients, ?30 per day, this would encourage GP retention and increased sessional commitment.

 

 

 

 

 

Not sufficiently, There is the TCOP fund, This goes part way to doing this.

Social care needs to be supported for health care to work.

 

Why not mandate continuity of care, by requiring 20minute appointments for patients’ over 80years of age. Why not evaluate whether they have been offered continuity should they have requested it.

 

 

1)      Recruitment,

2)      Retention, The exodus of GP’s to other jobs or other countries with better working conditions,

3)      Stress management,

4)      The attrition rate of junior GP’s to stress/burnout.

5)      Loss of the partnership model and loss of all continuity of care.

 

 

The media coverage needs to improve. 

The goal posts need to remain still for a while, Depoliticise the NHS. ?Kings fund report, is this going to happen.

Political agenda’s, frequent changes of health secretary, with opposing priorities, (yes we did what you asked Mr Hancock re remote access and now we are paying the price when the goalposts move)

Change is exhausting.

Please let us improve and do our jobs well.

We are caring professionals who did not enter this to get rich or fail patients.

With 3 A A-levels, we could have gone into Law or finance but we chose medicine, To CARE.

If the health service is to be privatised, please do not do this by stealth, be honest with the public and the professionals involved.

 

The volume of emails is crippling.

MHRA alerts for incorrect Patient information leaflets for drugs which I rarely prescribe, ?is it essential that I see and acknowledge all of these?

 

Online training for fire safety/manual handling and Prevention or radicalisation.

LMC updates,

PCN agendas and minutes,

New ARRS roles training, contract renegotiations, and SOP’s. This doesn’t leave any time for Professional CPD which presumably the public would expect their GP’s to engage with.

When, during a non stop 12 hour day, can these emails be read?

 

Secondary care are passing more and more patient requests to us, these often breach prescribing guidance, and surpass our generalist knowledge. 

Responding to say no takes more time and degrades relationships.

The crumbling of secondary care is having a big impact on primary care.

Standards of patient care in hospital have fallen, patients are not being ‘sorted out as thoroughly during admissions, discharges have been rushed and patient safety compromised.

The inability to book an ambulance transfer from primary care is also placing additional strain on our services.

We are getting multiple requests from patients regarding long waits for outpatient and inpatient procedures, and the patient need/demand further reassessment in the interim.

The uncertainty of managing disease without rapid access to diagnostics or specialists is deterring many of the trainee GP’s who I supervise from wishing to continue on their GP career path.

 

I am aware of colleagues in secondary care who are paid overtime, or incentivised to run ‘waiting list’ initiative clinics at double their usual pay rate. The consultant contract seems in many ways protected with SPA’s and sessional admin allocation.

 

We must be able to say ‘we are full’ in primary care.

Infinite work load and flogging GP’s and systems until they fail is not good strategy. 

 

 

 

 

No, It has increased the meeting requirements, liaisons, complexities, negotiations, it has resulted in a state of constant flux. The PCN did help with the organisation of the covid vaccination programme, The centralisation of services may have benefits but I think it is too early for these to have become a reality yet.

It has been difficult to recruit staff of the appropriate standard and ability, and when we have, they have not left shortly after being trained and employed, partly because they have been split across 5 sites leading to a sense of isolation and nomadic working.

(this includes pharmacists, First contact physios, Social prescribers, community connectors and mental health nurses)

This is disruptive to the practices and teams, it is unsettling generally when people keep leaving.

 

 

As above, This has in my experience been limited, Insufficient support networks from a stretched PCN team and Primary care practices has been a key factor in the lack of success here.

The ARRS roles seem to have been restricted in their release so that all practice PCNs are ‘fighting’ for the same professionals simultaneously,

Would it be possible for the ARRS rules to be relaxed so that we could use the money as the PCN chose, eg. potentially 5 pharmacists, or 5 social prescribers if that was what we could recruit, rather than having to specify and then losing the money when the vacancy goes unfilled.?

 

The other noteworthy component to this is that other professionals can not emulate the over arching decision making role of an experienced GP.

The volume and enormity of decisions which I (and my colleagues) are making on a minute to minute basis is frightening.

 

GP decisions are not protocol driven, rigid or formulaic, These decisions are made quickly, balance many factors, They are made well and made from experience. 

 

Please fund Primary care because we provide exceptionally good value and are highly skilled. 

We are the bedrock of the NHS.

 

The GP and wider practice team who I work with are hard working and resourceful. 

They are also exhausted and are becoming disillusioned.

They want to continue to do a great job, more investment is required to sustain the service, it can not continue to function on good will.

 

My fear is that, that immense, irreplaceable clinical and leadership experience will soon be lost to a generation who retire early or opt for portfolio careers which preserve their own sanity.

The job has lost a lot of its enjoyment and satisfaction.

 

The only opportunity that I have had to write this document is during my precious annual leave. 

There is no time.

 

Please help to save General Practice and the NHS now.

 

Dec 2021