Written evidence submitted by Dr James Wilde (FGP0144)

I am the Senior partner in a small-medium sized GP practice in Bournemouth with 22 years of experience in Primary care. I work 8 sessions per week starting work at 06.45 each morning so I can tackle the paperwork in peace. Each session is between 5 to 6 hours

Barriers to accessing General Practice – too much demand, too little supply.

Demand

a) Unrealistic expectation of what General Practice offers driven by the media and government;  `If in doubt  see your GP` message on the 10 o`clock news in response to a public health scare. Patient charters and `rights`. Patients feel fobbed off if signposted to an allied clinician.

b)  Easy access to 24 or 48hr response via E-consult. A significant proportion of E-consults submitted on Friday have resolved by the time they are answered on a Monday.

c) Instant access culture & expectation of modern society.

d) Lack of education and support for self help. Public health prevention & self help would be more effective targeted through social media & popular TV dramas. An obese child on Eastenders being teased & then developing diabetes is a powerful message. The commonest prescription we give is reassurance.

e) Excessive bureaucracy from multiple sources. On an average Monday I have 6 hours of patient contacts and 6 hours paperwork.

There is a significant amount of paperwork asked of us, much of which we charge for privately or get remunerated for, that requires `GP` input which is onerous, takes us away from clinical care and we would rather not do.

Examples of requests in the last 2 days

• Patient request for a letter in support of Personal Independent Payments
• Letter from Criminal Injuries Compensation Authority wanting information – 2 pages, 10 questions.
• Letter from Independent Assessment Services, request for medical evidence

Examples of other requests.

• Form to complete a marathon in France
• Form to complete a parachute jump.
• From to undertake a recreational scuba dive
• Foster Carer medicals with over detailed assessments required such as waist circumference measurements.
• Letters from employers for information on fitness to work with pages of their job description to `help` make a judgement on work- based adaptations.

Supply.

a)      Dwindling GP numbers due to work pressures, demoralisation and a cultural shift. Ageing experienced GPs heading towards retirement and reducing their hours because the current work pressures and pace that is unsustainable versus salaried GPs & locums with fixed working conditions and good pay. The partnership model begins to look unattractive. If all the partners switched to salaried contracts there would be a significant shortfall in GP time. A half time GP on 4 sessions is equivalent to a 6 sessioned salaried GP.

b)      Lack of effective triage of the demand reduces supply. A significant quantity of demand does not need to be addressed by a GP. There can be a limited amount of lower tier triage at administration level but evidence shows the more senior the clinician the better the triage. A 2 tiered triage process admin + senior clinician with access to allied supporting roles – pharmacy, physio, advanced nurse practitioner, nurse, paramedic, mental health support, social worker or CAB equivalent, social prescriber.

c)       A significant amount of our time is taken with mental health support. We listen, reassure, empathise and signpost. If you don`t have the time then medication is more likely to be issued. This former role can be provided by mental health practitioners as part of a local network.

The best use of a GP is to undertake effective clinical triage, have the time to see & assess the complex patients (15minute appointment time minimum) & in a network, be able to influence and direct provision according to local need.

There is no `cap` to the daily numbers we see, no flag we can raise when work pressures become dangerous & you are hitting 70-80 contacts 10 to 12hours into your day.

To attract GPs you need to simply provide better sustainable realistic working conditions. I love my job but its bloody hard & I would like more time to do it properly. Having a `named GP` is just a bureaucratic process. Patients will migrate to who they know & trust best. 

A GP has a unique, priceless skill set within the medical profession with our hospital colleagues becoming super specialised knowing more & more about less and less, dealing with their narrow interests then referring on.

Patient based, evidence driven medicine is the gold standard approach & to apply this process you need to know your patients, their families, their back catalogue, their working environment and so forth. If you can filter out the 50% of demand that does not need this approach we can have time to give the care we do best to those that need it.

Dec 2021