Written evidence submitted by Hornsey Pensioners Action Group (FGP0158)

I am submitting evidence to the Health Select Committee from Hornsey Pensioners Action Group (HPAG).  HPAG is an independent, self-funded group of people over 55 residing in or near Hornsey, London. HPAG is affiliated to the National Pensioners Convention. We have a membership of about 140. Attendance at meetings is normally 30. Our website is www.hornseypag.org.uk

The group wants the Health Select Committee to appreciate the importance of General Practice that carries out a large proportion of healthcare. GPs are the immediate point of contact for patients, yet General Practice funding is at most 10% of the total NHS budget, unlike other OECD countries where the average proportion of healthcare spending on General Practice is 14%.  Funding for General Practice must be increased - especially while we cope with the current pandemic. In fact, GPs do much to relieve the strains imposed on hospital critical care.

Our group is particularly concerned that the current emphasis on telecare, e-consult etc., should not detract from the proven effectiveness of face-to-face consultation for successful diagnosis. Many examples of where face-to-face consultation was essential can be cited.

One of our members, Betty Cairns, says that it is essential that patients can see their GP face-to-face. She gives instances:

A consultant conducted a long and thorough telephone interview before asking for tests by a nurse  practitioner. The consultants letter to the patients G.P. read ”nurses ...report shows  a marked and serious postural problems. HAD I SEEN THE PATIENT I WOULD HAVE NOTICED IT AT ONCE”

A young G.P. tells me that for women suffering domestic abuse a “safe” talk with their G.P. is next to impossible by “phone or computer.  ”Only when you see the bruises on their faces and the classic defence marks on their hands can you get them to talk

The Government is clearly eager to move as many consultations as possible to zoom or on line, The problem here is that those who are mostly likely to need medical help are the elderly but it this group who is most likely to be computer ignorant.

Many of our members do not use smart phones and are not online; they should not be excluded from easy communication with their surgery.  However, communication by email or text is helpful for those with hearing loss.  Betty Cairns adds that:

In 2020 15,120 people in the UK were over 100. 8.2% of the population of the UK in 2019 were over 75. These are people who cannot, in most cases, have any skill with computers and find telephone conversation (because of deafness) very difficult.

Our group recognises that small practices, where patients can consult a named doctor, are more efficient and give patients greater confidence. Measures must be put in place to avoid large commercial companies taking over GP practices. We have had to oppose such take-overs in Haringey. Privatisation of this sort results in poorer care at a higher price; sometimes with closure of the practice taken over.

General Practice has been under strain during the pandemic and we are grateful for the dedication of our GPs. It is recommended that increased collaboration between practices is encouraged for joint projects and sharing of administrative support.

Even before Covid there was a 10% vacancy rate for GPs and other Primary Care staff.  Ways should be sought by which recruitment can be improved, knowing that trainees will not be ready for several years.  Examples are returnee schemes and fast tracking of refuge and asylum seekers with medical or other heath qualifications. Betty Cairns adds:

Short of finding more skilled G.P.s (almost impossible), one way would be to move certain patients from the surgeries. I have noticed, in the media, the numbers of people who say they need face to face consultations to discuss mental health problems. In other words “talk therapy”. Haringey runs a very successful Grief Counselling service. If this Service were to be extended to general mental wellness it would save GPs a great deal of valuable  time

The Health and Care Bill introduces an extra burden upon primary care in ‘Discharge to Assess’.  This should be scrapped.  It is likely to lead to unnecessary re-admission to hospital.

There are many Older People Reference Groups in Haringey and other areas that would be able to suggest ways in which Primary Care can be strengthened. So far, these groups have not been consulted.

 

Also pasted below is the deputation statement on November 26th 2021 for the Joint Overview & Scrutiny Committee for North Central London. This was presented by Brenda Allan and Alan Morton of NCLWatch and HKONP and the text will also have been published on the Haringey website Agenda for North Central London Joint Health Overview and Scrutiny Committee on Friday, 26th November, 2021, 10.00 am | Haringey Council

Janet Shapiro (Hornsey Pensioners Action Group)

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JHOSC November 26, 2021.  Deputation: Primary care pressures

 

1 Introduction

Since our deputation in June, the crisis facing primary care has grown and received greater adverse publicity.  Year-round winter pressures, exacerbated by the pandemic, have left anxious patients facing another winter of reduced services, and uncertainty about accessing timely care.  Additionally, trends accelerated by the NHS’s responses to Covid 19, with increasing weight placed on e.g. e- consult and Total triage, are adversely impacting many patients, causing further frustration and risk, with postponed access to appropriate, sometimes lifesaving care. 

 

Demographic factors in NCL - deprivation, age and diversity, all highlight the need for very robust, well supported primary care services – handling as they do 90% of patient contacts, and winter only intensifies this need. If general practice fails, so will the NHS, with patients diverting to emergency departments (ED/A&E) and other unscheduled care provision. Some Local Medical Committees reported that GP practices could close on a temporary or permanent basis this winter. (1)

 

We urge the JHOSC to press the CCG/ICS as to what additional, effective support it can give primary care, to ensure patients can access timely, safe care, during the winter, by addressing the workforce, workload and stability of provision issues.

 

Our view is that some pressures and risks to local patients are the result of longer-term priorities of NHSE, particularly the move to supersize practices, relying heavily on e-consult and other remote services. Recently a practice with an Inadequate CQC rating in Haringey  was taken over by the Hurley group, a large south London practice, and an  early and heavy user of e- consult. Local Healthwatch findings indicate an association between e- consult and increased A&E attendance, an alert that patient views need to be more seriously considered.  While e-consult and other remote contact is convenient for some patients and some routine  appointments, it is not easy or appropriate for others. In addition, providers relying heavily on e -consult and digital provision, tend to attract fitter, infrequent users,  leaving  sicker patients to over-burdened, traditional GPs with attendant financial disadvantages.

 

Mega practices pose risks to provision if they sell to a large profit-making health care organisation. as with AT Medics, and  one of the Centene practices has already been judged unsafe by the CQC. Legal opinion  obtained for the Judicial Review was that  commissioners were wrong to assume that they had limited grounds to refuse the Operose acquisition, failed to consider the financial risk to GP services, or the financial suitability of Centene, given controversies over access to healthcare and fraud in the US, and failed to consult patients and stakeholders. (2)

 

Research suggests that patient satisfaction levels are lower for very large and private company practices, as compared with smaller ‘NHS’ practices, so the type of primary care contract matters to patients. (3)

 

2. Recommendations -we urge JHOSC to press NCL on the following, and monitor progress:

 

3. Pressures

GPs and other members of primary healthcare teams have faced a massively increased workload over many years, with a growing and aging population, the pandemic,  secondary care moving more tasks and patients into the community, and more patients with long term conditions managed at home, but without adequate resources flowing into primary care or social care.

 

Discharge to Assess, enshrined in the Health and Care Bill, will only add to these pressures. Demoralised GPs are leaving, retiring early, or working part time etc,  piling on further pressure, with the danger that practices may close/fail. Eight practices in NCL received a Requiring Improvement rating by the CQC, and three were rated Inadequate, the latter all in Haringey.(4)

 

There was a 10% vacancy rate in the NHS pre-Covid, now higher, a major shortage of GPs, nurses and other primary care staff, and major difficulties with recruitment and retentionIn NCL, nearly a third of GPs are over 55 years and about a half of nurses, except in Camden, highlighting the need for a massive succession planning effort, in addition to addressing the current shortages.

 

Funding for primary care has shrunk as a percentage of healthcare spend to under 10%, well below the OECD average of 14%. NCL CCG/s Annual Report 2021, noted a cumulative deficit of £112,000,000, which given that ICS budgets will be capped, raises the prospect of massive cuts to services, including primary care, unless transitional funding is available.

 

Brenda Allan & Alan Morton, NCL NHS Watch & HKONP

 

(1 ) N. Merrifield, Pulse, 3 August 2021

(2) Phantom of the Operose,  Private Eye, no.1560, 12-15 Nov 2021

(3) Cowling TE et al. Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey. JR Soc Med 2017;110:440-51.                                                                                                                                                                                                                                                                                                                                                                                                                                                                

(4) NCL Primary Care Commissioning Committee 21 Oct 2021.

 

Dec 2021