Written evidence submitted by Dr Alastair Ward (FGP0131)

My experience is that there is no barrier to accessing general practice, there is more access now than there has ever been, by digital presentation/e mail/e consult as well as telephone queries and  people presenting at the front door. What is more of a problem is the lack of support from  the government and media into using the resource properly. The system is not resourced enough in terms of workforce to deal with these demands, expectations and ARRS staff will never be able to fill the gap.

 

The message is always “see your GP”, even sending people to the local pharmacist ends up coming our way when they say “see your GP”, NHS111 the same (it’s always unrealistic time frames issued and the patients then brandish these like a weapon only further increasing unrealistic and unwarranted expectations.

 

General Practice is expected to perform acute responses as well as  health prevention and  chronic disease management as well as responding to a call for vaccination of the population. There is no way we can do it all. If successive governments want to break the model of general practice and end up with a collapsed system that will be replaced by a patchwork private system, then carry on loading more and more expectations on to us. The workforce is demoralised and tired and the major challenge that primary care faces is keeping enough  GPs in the system to make it work. ARSS staff and others will not keeping working to absorb all the work thrown at them, they say “we have reached capacity”, I have never said I have reached capacity see someone else, so end up working faster and longer and this is not sustainable.

 

Development of PCNs does not help rural  groups of practices that have not merged, this creates yet another tier of bureaucracy that expects a lot more of our  GPs who are engaged in the process and the time of practice managers. This is the one thing that wakens me at night and makes me want to throw in the towel. PCNs can work for large practices in urban centres if the admin is within only one organisation. But if you have 6 practices (mixed rural/dispensing /single handed and small town in a geographically spread out area ) it does not work at all and is something which is alone likely to break the model of general practice. WE as a group do not want to merge and become salaried GPs, if forced in that direction we would have mass resignations. We are, as a practice considering whether we will  continue with the PCN DES next year. PCNs increase bureaucracy and the complication of  delivery of care and make it more piecemeal, pts end up seeing so many people either reduplication of work or passing work sideways so that there is so much delegation there is an awful lot of work being done for very little (if any ) gain.

 

The current model of general practice is sustainable if the government want to support primary care and actually make some positive statements backed up by consistent messaging to the wider population to use the resource of primary care and  casualty/ambulances with care otherwise they will be lost forever and the NHS will collapse.

 

Current payment and contracting arrangements are just too complicated and piecemeal and there are too many hoops to jump through for all the different strands of funding.

 

I have in the past liaised with other organisations and the voluntary sector to develop  Public Health projects, these work well and are lauded by the CCG etc but then never supported to develop into anything meaningful and longer term. There needs to be more flexibility at a local level to support projects without the top down hierarchy that always seems to hold sway over management of primary care.

 

To end some pleas for action.

 

  1. Make the contracts simpler
  2. Make payment structures simpler with less reporting and box ticking
  3. Dismantle PCNs for rural communities or in those areas where they patently do not work.
  4. Promote sensible use of the NHS across urgent and primary care from central government with clear and consistent messaging, be brave about admitting that unless people change (including politicians) the NHS will collapse as a system and we will have some form of private system instead.
  5. Address the BMAs concerns re pensions as this in itself is a significant factor in the decision making of older GPs into whether to remain in the workforce or resign.

Dec 2021