Written evidence submitted by Janes Isaac (FGP0137)

Next Five Years

In inner cities where there is deprivation, mental health, homeless people, and patients who don’t have English as their first language or can’t read or write English, access to services is very difficult. You can’t expect this type of person to pick up the phone or email or write a letter or response to a text to get health advice. You need to get clinical staff to ring these patients to talk using an interpreter if needed to get their engagement. These are the most at need patients, often they have been in prison on numerous occasions. The NHS needs to give extra time to deal with these patients 10 minutes isn’t enough? Funding for the extra time such as 20 mins reduces the pressure on clinical teams, patients and other services. If patients cant access their surgery or don’t have a surgery, they will go to A&E so getting capacity right in general practice is key.

An APMS contract where there are no partners does mean all the work done by the partners has to be paid for, partners do a lot of unpaid work to run their businesses, working on a APMS contract model costs more.

Having a named GP links into having a list of patients who they support their patient for continuity of care. Having to use locums means there is more pressure on the registered GP as they don’t do all of the job and can cost £85 per hour plus NHS Pension. If a surgery is under too much pressure staff won’t want to work there and this increases the need for locums which then increases the registered GP work and costs. Using PCN staff to fill the gaps of GPs doesn’t help with the number of patients that the registered GP will hold and all of the paperwork results go back to the registered GP. PCN new roles has helped to give a wider offering to patients however they can’t replace GPs. GPs work is getting more complex and taking longer as the easier part of the job is now being done by ANPs, Physician Associates etc. It is really important to reduce pressure in the inner city and areas of deprivation with the correct funding to support the extra strain and to encourage staff to want to work there. Management play a large part in this and communication. Having a learning culture is key and having an organisation where staff feel safe to raise issues (‘organisational Safety’ )will increase incidents but this should be looked upon in a positive light by the CQC & CCG as these organisations review and change things before there is a patient safety issue. This will improve morale and ensure staff want to continue to work in a tough environment. Having good quality managers who understand about these issues and work toward this is key, although it takes a number of years to achieve this.

The main challenges facing general practice in the next 5 years is a lack proper funding in the inner cities, lack of GPs, lack of trained admin workforce & lack of nurses which affects capacity and increases burn out.

Freeing up time for GPs and all of the work around ‘Productive General Practice’ has meant that instead of working 2/3 hours per day unpaid, GPs can work less unpaid and get home a bit earlier so improving health and wellbeing. A happy supportive friendly workplace is key to this as it reduces recruitment costs and sickness levels. Good leadership and management is key.

Getting a good clinical system that works and is quick helps to retain staff which helps to make the working day manageable. GPs do a lot of extra work outside of the 10 mins appointment when they have to admit patients or refer them onto secondary care for scans etc which again adds pressure. Linking up the computer system so that other health care professionals can see the GP record has been a brilliant step forward.

There needs to be a standard model of how many calls, how long they take and lines in and out of the surgery around the population size and deprivation to ensure patients have the correct access, as well as having front door access if they can’t use the phone as they don’t speak English. This all takes extra capacity that needs to be funded to help keep patients safe and well as all of the staff.

Dec 2021