Written evidence submitted by Jenny Whittle (FGP0138)

 

Public perception of General Practice has been negatively affected over recent years mainly due to the media misrepresenting GPs and negative comments from politicians. This has been incredibly detrimental to the morale of the workforce and is partly responsible for many people deciding to leave the NHS. In addition, whenever there is a health campaign, the take home message is ‘see your GP’. Even with the Covid Vaccination Programme, the BBC were advising patients with queries about the vaccine to ask their GP.

 

For me, the turning point was when the general public were advised that they would be able to see a health professional within 24 hours and a GP (of their choice!) within 48 hours. This had a massive influence on how the public viewed GPs and medicalised many problems that would have resolved. The genie was out of the bottle and the rot set in.

 

The main barriers to patients accessing General Practice are the reduction in the workforce, largely due to doctors and nurses leaving the NHS because of the increase volume in workload and the increasing demands from patients.  There is an ageing population that are getting increasingly complex medical conditions and often patients have more than one problem that they need to discuss.

 

The plans to increase the workforce and make it more diverse can only be achieved by training up more people to take on the roles. Additionally, there needs to be attention to where this workforce will be situated. GP surgeries often cannot physically accommodate any expansion in workforce. NHS England had a plan to introduce more digital solutions, which general practice has striven to adopt, even though many clinicians found these solutions difficult to manage. Now general practice is being told to focus on face to face contacts, and digital solutions are unpopular with many patients.

 

The main challenges facing general practice in the next five years are the ageing and decreasing workforce, premises that are not fit for purpose and a population that has been given the right to demand and expect more. This is not sustainable, and the Government/NHS England should put efforts into educating the general public in appropriate use of services and make it clear that services are finite. It needs to be a balance of increasing the workforce and capping expectation.

 

The Primary Care Network DES is a one-size-fits-all model and does not work effectively for practices that are not geographically close. GPs and Practice Managers are being forced to be involved or they risk losing funding for their practice. Creating an ARRS has caused a great demand for the roles listed. PCNs have to spend time setting themselves up to become employers of the new workforce and there is not the capacity in the system for the management time involved. I believe time taken out for GPs to be involved in the PCN is detrimental to patient care. GPs are expected to become managers and this is not their skill set. The change from CCG to ICS is yet another ‘here we go again’ moment. Why can’t Governments just let the organisation consolidate rather than reinventing it every few years?

 

GPs should be involved in prevention, but it should not be the sole responsibility of general practice.

 

There is far too much bureaucracy in the NHS. GDPR is responsible for an increase in the workload, particularly with patient access to medical records. I believe patients should be able to access medical records, but it is a painstaking and time-consuming process ensuring that there is no third-party data or information that may cause the patient harm within the record. This is unfunded work.  A contributory factor to burnout is the level of work devolved from secondary care. It is not uncommon for consultants to ask GPs to follow up test results, arrange tests for patients, refer patients to other services. Patients often come to the GP to resolve issues with other health providers.

 

I believe that it is vital that we make the current partnership model sustainable. It is about ownership. I believe that if primary care was run on a salaried GP basis, access to primary care would be adversely affected.

 

The current contracting and payment systems are far too complicated and often cross over, so you have elements of the same things under different contracts. It makes it very difficult to keep track of what you should be doing and when and wastes time.  Primary Care Networks have increased the administrative burden on GPs and added in another layer of bureaucracy in my experience. Payment structures should be simplified and PCNs

 

Working with other professionals has had some benefits, but it is not unusual for problems ultimately to come back to the GP. For example, patients contact the pharmacy or NHS111 and are advised to see a GP, there are often requests for GPs to make a referral as a result of the patient having been assessed by a social prescriber. My perception is that these additional services are just that, as well as, not instead of. Patients need to have affirmative experiences to change their perception of the services so that they don’t feel that anything other than a GP appointment is a lesser option. It has been helpful having a clinical pharmacist, but we have not experienced any freeing up of time as the workload has increased.

 

To summarise, I firmly believe that the general public should be made more responsible for their own health. The public health message should be strong in encouraging people to look after themselves and make healthy choices and to use the services appropriately. This needs to be supported by the media and politicians. This level of demand and abuse of the system will cripple the NHS. The contracting and payments system needs to be simplified, and Primary Care Networks need to be allowed to disband without any sanctions where they are clearly not working.

 

Dec 2021