Written evidence submitted by Dr Catherine M Bayliss BM DCH DRCOG DFSRH MRCGP (FGP0146)

 

I am submitting evidence to this enquiry as I work as a General Practitioner in Hampshire.  I have been a GP since 2004 and a Doctor since 2000.  I worked as a Partner in a practice for 12 years. I left partnership in 2016 and then have subsequently worked as a locum GP, GP Appraiser and also supporting practices in difficulties for 4 different CCGs across the Wessex region.

The first barrier to accessing General Practice is the challenge of what patients need versus what they want.  General practice has very much been in the spotlight during the pandemic and has become a target of a media campaign regarding access.  There has been this complete myth that General Practice has been closed during covid.  In my personal experience, this has been untrue.  The profession followed NHSE guidance regarding remote access initially and as different waves of the pandemic have progressed, we have adapted and changed appointment template models to fit what the local patient populations have needed in order to provide safe healthcare.  Sadly, this is not what has been perceived in the media to be what the population wants. 

 

The patients I have worked with over the past two years have very much appreciated the various routes of access.  The role of telephone triage has meant that the pre-pandemic waits of 2-3 weeks for a face to face encounter with a GP have evolved into the ability to discuss their issue with the Doctor within 3 days and for the most part, same day.  This has worked well for younger populations who work as they do not have to take time off from work to make the trip to the surgery for their health care needs.  I have seen patients face to face continuously since March 2020.  I have worked at covid hubs and “red sites” and within normal general practice and face to face appointments do still have a role.  They are needed though for about 30% of the patients I encounter.

 

Incidentally, our practice nurse and health care assistant colleagues have seen patients face to face continually due to the nature of the work that they carry out in the practice.  They should receive praise and recognition for the vital role they play in primary care.  Some chronic disease follow up is done remotely, but these remote consultations are still a small proportion of their work.

 

The other issue regarding increasing face to face appointments is the inefficient use of time.  More consultations can be carried out per session worked with telephone/e-consult appointments than face to face appointments, especially with PPE still being required and room and equipment cleaning after each patient.

 

Respect should be given to General Practitioners who are consultant grade doctors who specialize in primary care and the judgement that they have given as to what is best for the population they serve.  GPs know their populations of their practice extremely well and are an extremely efficient and effective use of NHS resources, especially as we carry out so many patient encounters for the small proportion of NHS budget allocated to the service.  It is not what the media/some of the public wants, but with a free at point of contact service, extremely good care is being given

The impact of patients not being able to access what they want from General Practice manifests in several ways.  They will call back to the surgery asking for a different practitioner/further consultation, they will complain, or they will seek access from other health care providers such as the Emergency Department.  Unfortunately, as the myth of General Practice being closed has persisted, patients have decided to access other services without even attempting to access General Practice which is adding to the pressure elsewhere.

 

Some patients are still very scared to access health care due to the pandemic.  This is affecting their chronic disease management and heightening health inequalities. 

 

The named GP would be an ideal situation for patients if we were working in a well -funded, well -staffed primary care service.  I am currently working in a practice with a list size of 13500 patients and there is only one permanent GP member of staff and they work two days a week.  The rest of the GP staff are locums.  Fortunately a lot of the locums are long term in order to provide some continuity of care but traditional, list based General Practice is impossible in that practice. 

 

When I was a GP partner, I did get to know my list of about 2000 patients.  That had pros and cons.  Continuity of care reduces number of consultations and improves efficiency and effectiveness of the consultations, and indeed, knowledge of the family/social situation added the extra dimension to contextualizing that patient’s problem.  I would still argue that you can achieve continuity via using all the different means of consultation and not just being able to see the GP.  The down side is that only ever seeing one GP can mean that certain things can be missed which are seen when a patient has a GP who takes a fresh look at their case.

The main challenges facing general practice in the next 5 years, in my opinion are:

 

Regional variation does affect General Practice.  Even within one CCG area there are more desirable practices to work in and others that GPs avoid.  There are significant funding differences between areas and this affects the attractiveness of a practice to work in.  Also the social issues of where you want to raise your family and work also determine which areas you want to work in as a GP, especially if you have the luxury of choice.

 

General practice are well placed to support preventative medicine.  It is a significant part of the work we already do – optimizing patient care in order to prevent worsening chronic health issues.  We also provide family planning, immunisations, cervical screening, health checks and other ad hoc services. Patients prefer to come to their own practice for this as it is a familiar environment.  All we need is enough funding to support the staff and premises to provide these services.

 

What can be done to reduce bureaucracy and burnout?

 

The current model of General Practice needs significant improvements in funding to reflect the volume of patient encounters it handles for the NHS.  With a significant increase in funding, practices would be able to recruit larger teams, pay them appropriately for the hours they do – General Practice cannot afford Agenda for Change conditions which is why they have historically been exempt. 

 

 

 

 

I personally feel from my experiences working in General Practice that we have come to a crossroads and some huge decisions need to be made about how we work in the future with the limited number of GPs we have.  I can see a multidisciplinary team of GPs, Advanced Nurse Practitioners, pharmacists, practice nurses and HCAs working together to look after a list of patients to provide their care needs rather than a GP alone.  GPs need to be used to deal with the complex cases rather than a lot of the day to day care that we have done previously.  We are the General Physicians that disappeared from hospitals just after I qualified as a doctor.

I want to remain a GP. It is an amazing job and has a lot of opportunities when the system is working well.  I am in my mid-forties so should have at least 20 years left in the profession.  I do worry at this rate that I will have to consider other career options by the time I am 50. 

 

Dec 2021