Written evidence submitted by anonymous (FGP0193)

 

I am grateful for the opportunity to submit my views. As a career GP I have over 30 years experience of UK general practice.

 

I believe all that I have stated is correct but ideally my name would not be published. Speaking truth to power is not always a comfortable process for the honest. These are my own opinions and I am not speaking on behalf of any partnership, employer or NHS organisation.

 

I apologise if I appear passionate or opinionated but I believe UK general practice and the partnership model have enormous strengths and benefits to the whole NHS.

 

It is quite simple, there are too few qualified GPs wishing to do the job.

The problem is not the GPs, not the GP partnerships but what you are expecting each one to do in a day.

This has been clear for many years but the solutions tried so far have not worked.  You need a core general practice job that many doctors wish to do and stop the process of government, patients, and the rest of the NHS expecting that a GP will do everything. If it is funded, the core GP job will provide adequate access.

There is little point in changing telephone systems or using Apps until you have addressed the issue - why there are too few qualified GPs wishing to do the job. Rearranging the chairs on a sinking titanic comes to mind.

In my career many ‘experts’ have been employed to sell their systems. Whether it be ‘advanced access’ or ‘doctor first’ or a company who says their app is the answer. Please be aware that at the end there is always a doctor consultation for efficient care.

 

The GP job is not understood and not respected. UK GPs come out in international comparisons as dissatisfied and with a high workload. Until the NHS stops thinking ‘the GP will do that for free for the NHS” the problem will not change.

As a consultant explained it to me - he thought he was saving the NHS money by not seeing the patient in his clinic but expecting me to do the work he wanted done in my GP surgery.

Even with the massive expansion of training the problem will not go away. Many of the younger GPs will wish to work part time and will need parental leave. My generation of full time GPs are now retiring in droves.

You have created a pensions scheme and pension taxation regime that economically forces doctors who work full time to retire in their late 50s. You have removed seniority pay which used to encourage senior doctors to work in their 50s.

You have decided that if ever I work hard enough to earn over £150 000 from the NHS my name would be published nationally. Clearly you do not like me and do not want me to carry on working as an NHS GP –message received you do not want me to work hard.

In the middle of a pandemic the NHS launched a ‘name and shame’ campaign on the NHS GP practices with the lowest 20% of a metric they just invented. Certainly many GPs believe that there was political briefing against GPs to the national press in the second half of 2021. Clearly this ‘encouraged’ all those GPs who had worked tirelessly during the pandemic. Many of us had set up and worked in vaccination centres doing many more hours than their normal working time. Message received you do not want us.

You have an appraisal regime that appears burdensome to appraisees approaching retirement. Instead of continuing to do some work it is easier for them to stop work entirely. Message received you do not want us.

NHS GPs are demoralized because of the way they have been treated. We actually have skills but clearly they do not appear to be valued enough that doctors want the job. Many UK GPs I know now work in Australia.

 

 

 

 

 

With respect I cannot see how these will actually help. There is already a demoralized, exhausted workforce. Throwing in a little extra money over one winter is NOT the solution. Perhaps allowing GPs to explain what work they should be doing and what has little value or can be done by others would be a way forward. ‘Improving access for patients’ appears to GPs to be a euphemism for ‘force the exhausted, demoralised GPs to work even harder’.

If patients do not get care then there may be suffering. However the impact of not being able to use ‘their preferred method’ may be beneficial. I am not trying to run a shop where having more customers is always better. I am trying to invest NHS resources where they will help most. It may be better that we do not have a major Facebook GP presence for the worried well to ask questions but ensure that the elderly with major needs are not denied care by an insistence they use the internet.

Having too much of a proliferation of ways to contact a GP, email, Apps, SMS, telephone, in person at reception, practice website, nhs website, and direct appointments booked by NHS 111 may not be the best use of resources.

 

I do not contact my MP using my preferred method- which would be phone or text. I contact him using an adequate one that works for him – email.

It may be that the ‘Tesco Generation’ want it now and will turn up at Emergency Departments. I strongly recommend that such departments deal with emergencies. Routine things should not be dealt with by emergency departments. It might well help such departments to be able to access GP records as sometimes patients are just seeking second opinions.

 

Patients appreciate continuity. I see no major merit in one named GP who will have to have days off and holiday. There is however a major benefit in a small professional GP staff team who work together. It is called a partnership. It is efficient if a particular doctor has a plan and reviews that patient at the next appointment. Patients frequently get lost in the NHS system. As we are the team the patient can find often we sort out their continuity even when it is with another NHS organisation.

 

Convince politicians that it is not a football to be used for electoral advantage but a resource to be developed. If politicians and the wider NHS resource practices, and understand what we can and cannot provide then it could again become a worthwhile career. Young, bright, intelligent doctors will not enter UK general practice unless they see it as a rewarding career. Please do not destroy what many of us have spent our lives building.

 

 

GPs are adaptable and adapt to circumstances. Rural areas have very significant distances to travel if patients are to be visited. It can be almost impossible to get locums wanting to work outside larger towns. Cities have problems of transient populations and often many ethnicities. GPs are adaptable and if the contract is right for their circumstances they will provide good care.

 

GPs and their staff can organise the individual advice and explain to patients about their smoking, alcohol and weight issues provided they are properly resourced. They will be most effective if combined with central policies on prevention that are not influenced by lobbies of alcohol, smoking or food industries.

Stop other NHS departments expecting GPs to manage their workload. They do this by complex referral processes, rejecting referrals, expecting GPs to get approval for referrals before referring, expecting GPs to do blood tests for secondary care. There is a belief that getting a GP to do the work ‘saves money’ (as the GP does not get paid anything to do it but the other NHS dept does). The NHS has a ‘system’ where orthopaedic surgeons will accept a referral to replace a left knee  but then immediately seek a further GP referral for the right knee. See earlier answers for how not to make GPs want to leave.

 

Yes it is a strength and promotes quality, flexible care. Many salaried doctors say they like working for a partnership not the monolithic NHS.

The partnership model has served general practice well. We are a small efficient, ethical business. Much like  barristers’ chambers, MoT test centres, local shops and MPs constituency offices -  a small independent office can serve a local population very well. Partnerships can employ those GPs who wish to be salaried  or locums. If you bring primary care into the larger NHS bureaucracy you may well kill it. The NHS can easily employ many more people to run inefficient bureaucracies to everyone’s detriment.

 

Integrated care sounds fantastic. I understand that some of the Trusts are ‘working on it already.’ Unfortunately as a GP they all are working on how I will integrate with them. They do not appear to believe that the big Trusts will integrate with me.  I fear that the grass roots GPs are already being sidelined by integrated care and we will just be told what to do again.

I work as a partner in a practice. I run a community clinic providing services similar to some in my local secondary care trust. No one seems to want to talk to grass roots on implementing integrated care.

If integrated care is to work I suggest close liaison with GPs and Local Medical Committees (LMCs) and do not let large trusts just run such systems.

 

They would if the rest of the NHS let us do our job and resourced us to do it. We have just been poorly resourced even compared to the rest of the NHS.

The problem is that too much is being expected by everyone for the resources devoted to General Practice. I weep when I see the amount to money and the number of staff employed in secondary care.

I then get phoned by specialist nurses in a hospital who say they ring me as they cannot find a doctor (within the hospital) to sign a prescription. 

There are 4.4% (circa 1300) fewer fully qualified full time equivalent GPs than in 2015. Consultant full time equivalent have expanded by 18% (circa 8000) over that time.

 

No.

Primary care Networks have to the large part been a distraction. From where I sit, providing daily patient care, I see no clarity of thought on the  creation of Primary Care Networks. In recent years there has been virtually no investment in core general practice. Message received you do not want us.

Instead there has been a plethora of initiatives with money thrown at them because that is the ‘solution’.

Clinical pharmacists, Social prescribers and PCN physiotherapists have not made any major change despite the amount of time and effort invested in PCNs.

 

 

 

 

GPs have always worked with other professions. I work with attached midwives, health visitors and pharmacists. I work with specialist nurses in palliative care, respiratory care, heart failure, stoma care and tissue viability. I work with paramedics. I work with Minor illness nurses and Advanced Nurse practitioners.

Having Advanced Nurse practitioners in my practice consulting with patients does free up time.

Many of the others do not prescribe so I still need to communicate with them and write the prescription. Every day I still can have 50 patient contacts and have a further 200 repeat prescriptions to authorize as well as many other patient related activities. We have always worked with other professions. Having most other professions to work with does not create an enormous amount of free time.

 

You have misunderstood we are crying out for GPs. Just recruiting more people to other jobs is not the solution. Just putting large numbers of doctors into GP training will not work if they do not like the job at the end.

 

 

 

 

 

Conclusion

A massive expansion in GP numbers is required to keep the NHS running. Unfortunately the action taken before has not worked. The solution will not be comfortable but the job has to be made into the job that people want to do for their career. Working in and for partnerships is not the problem. Others having unrealistic expectations what a GP can do is the problem.

 

 

I would happily give more detailed evidence if that would be helpful

 

I am still proud to be a UK General Practice Partner

 

 

 

 

 

 

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December 2021