Written evidence submitted by Barbara Sharp (FGP0142)

Barriers for Accessing General Practice

• management of telephone systems:
• too many people trying to call at particular times of day
• each surgery having it’s own telephone answering team
• insufficient use by patients of technology – they need help to learn to access modern methods
• poor management of local social media ‘attacks’ on individual surgeries (PCN’s could address this more centrally and proactively)
• Need more marketing/focus on other professions working within surgeries – not always necessary to see a GP for instance my role as MSK practitioner for back pain etc. Stop calling the buildings ‘GP Surgeries’ and use more inclusive terminology.
• 111 is definitely improving as it localises so the clinician knows what is available and can make the appointment directly as required/appropriate.
• Are Pharmacists competencies for minor ailments being supervised and mentored sufficiently?

Named GP

• I still feel this is important for patients with complex health needs, comorbidities etc where the patient needs a key stakeholder in their care. It is not necessary for one off or short-term concerns unless the patient has particular needs or the main problem is a speciality of a particular GP.
• I feel other clinicians could also be ‘named’ key workers, for instance if main concern is mental health, access to a suitably qualified clinician in primary care with contacts to the (better resourced) MH teams for non-emergency care would be helpful.

Main Challenges

• GP’s are not employed by the NHS and as such have to run business models for the practices. As they become more complex and larger clinical hubs this must be both time consuming and require more ‘back-room functions’.
• GP’s rely on QoF’s and other payments to bring income to their business, this may mean that some patient’s conditions are prioritised. If Primary Care was embedded in the NHS system with the opportunity for same pay and conditions as other NHS employees; this may also help integrate services.
• Radiology departments are not accepting referrals from Advanced Practitioners within Primary Care, even when they have all the competencies required by the Royal College, meaning GP’s are still having to sign and send referrals and therefore receive and manage the reports. Access to the images would further enhance the service to the patient in PC for those who have the ability to review the images.
• Mandatory training/competency training is managed locally and yet manual handling, hand hygiene, fire safety, equipment handling is universal. Its about time the NHS took back the leadership and was able to transfer the certification where-ever the individual is employed – including primary care. That will cut down on admin tasks in each surgery.
• Costs of disposable equipment purchased in bulk (via Amazon perhaps rather than the NHS services) would improve storage, delivery times and must help bring down costs.
• Staff are having to pay for training – without funding, my journey to independent prescribing would be around £21000 and not feasible.
• I do feel the traditional partnership model is outdated and should be considered redundant; however, subsuming community services into acute trusts doesn’t work either – for the community services as the money is swallowed by the acute.
• PCN’s are a good alternative to lots of separate practices; I’ve been around long enough to remember regional NHS services and maybe that would be a helpful start – co-terminus services with County or Unity Authorities. We are 3 PCN’s, one would be even more beneficial as long as managed sensitively and fears properly addressed.
• Utilisation of non-medics in primary care is generally well supported locally; I am an AHP working with paramedics and ANP’s including MHN and pharmacists to support our primary care GP colleagues. One of the main barriers is time and funding for supervision if we are not directly employed by the surgeries; this is a challenge which should be solved if we are to move forward.

Regional Variation

• The Isle of Wight has particular issues with staff recruitment, retention, accommodation/travel and as a small county cannot attract ‘specialists’ as there is a paucity of numbers in any one speciality meaning senior clinicians are unlikely to settle here. This is in line with other rural areas (I have also worked in Cornwall) but with the added burden of very expensive ferry journeys for those who would prefer to travel from the mainland or sharing services with either Southampton or Portsmouth for patients to attend. The ferries are private companies and although discounted add to the burden for both patients and staff.
• Suggestions might include (for other rural areas too):
• Funding the Island to have a speciality hub which would attract specialists to the Island and bring more patient’s across from the mainland
• Encouraging a larger private hospital presence offering NHS contracted services such as elective orthopaedics, gynae, ENT perhaps as a satellite of one of those nearby on the mainland/bigger cities
• Provide suitable accommodation for staff
• All of these may help reduce the reliance on very expensive agency staff and encourage clinicians of all specialities including Primary Care to consider the area as a permanent residence.

Prevention Agenda

• If the government are intending to continue to pay primary care to meet targets, then they will do whatever is asked. Whether this is really the best way to utilise NHS funds is questionable and certainly means other teams with skills more suited to prevention are not funded equitably. For instance, smoking cessation and weight loss teams struggle to be funded and yet GP’s have been known to attract funding ‘just by ticking a box’.
• Integrate MSK First Contact Practitioners into Primary Care for the future and give them direct access to, even leadership roles within exercise on prescription, healthy lifestyles, and teams who rehabilitate patients and prevent the need for orthopaedics for instance.

Dec 2021