Written evidence submitted by Park Lane (FGP0202)

We feel that there are multiple factors that can prevent patients from accessing general practice. We do not feel that the Government’s plan goes in any way to improve access for our patients. We feel that the major barrier is due to patient’s expectations with patients in cases expecting immediate attention for problems which are more suited for self-care. We also believe that patient’s are more demanding of the medical profession with their own expectations and will look to exploit the system to get what they think they want or need. Patients are often unprepared to accept any delay even when this is deemed clinically appropriate and their priority of need have been assessed.

IT remains a major barrier both for patients and clinicians. NHSE plan to make everything digital causes significant problems for a significant portion of patients. Outdated IT systems also hinder clinicians’ ability to do their job nearly on a daily basis. Stopping them from seeing patients and taking up valuable time.

On occasions patients will attend A&E while phoning ourselves and 111 while in the waiting room to see who responds first for non-urgent conditions. Patients need to be encouraged to use the right service at the right time and use self care when possible to allow the current system to continue for the benefit of all free at the point of need.

Having a named GP has no effect on continuity of care. Patient’s self-allocate themselves to GPs of their choice regarding certain matters when appropriate, as a practice we support this and look to make sure that complex patients are managed by specific GPs. Patient’s do like being told who they should see and therefore quite rightly will choose a GP who is able to meet their needs.

 

Retention of a workforce that has become disillusioned with healthcare in this country. Many GPs are looking at retiring early due to the stress and demands of the job but also the effect of negative campaigns against them. Patients are becoming more difficult to manage and this also has an effect. This situation also applies to non-clinical staff in particular practice managers who are the bedrock of any practice. GP trainees are not looking for full time GP work because of the demands and stress this this causes. Most GPs have significant estate issues which reduces their ability to make use of an expanding workforce.

Demands in different areas create different problems, current weighting of funding is significantly distorted to urban settings and does not take into account elderly frail patients who are more demanding and create a significant workload.

General practice is not able to take a significant part as the demands on it are so vast that it has become a reactive system. It spends significant portions of it’s time having to complete work with little patient benefit such as QOF and MMT targets. As GP’s we are happy to practise opportunistic health promotion.

Improved media communications around general practice and governmental support of it. Removal of many indicators of QOF that have become defunct and purely and tick boxing exercise. Increase pay funding to general practice to allow allied professionals to be paid more to help moral and retention.

Tackle the behaviour of secondary care. With more work being pushed out into the community (rightly) this rarely comes with funding or support. GPs are often left to pick up the pieces of this additional workload. We agree that the vast majority of patient care should be in the community, but this care has been driven out of the hospitals without any movement of funding or support for this workload.

 

The Partnership model is the only way that General practice can provide a cost effective safe and efficient service. If there was a shift away from this vast numbers of senior GPs would be lost and general practice would face significant difficulties. Our salaried doctors feel part of a small team and are valued as part of this. Removal of partners would require significant expensive management infrastructure to be put in far exceeding what it in place currently. GPs would not take on responsibility and would not take on extra workload merely turning up from 9am and leaving at 5pm as this would be written in their contract. Because of the team dynamic and feeling of belonging working for a small business GPs turn up at 8am and go home at 7pm because they want to do everything they can for their patients and their practice. The wider team also responds positively to the partnership model.

Individual practice development is completely partner driven and considers significant local knowledge of their population.

Some of it does but a lot of limited by the lack of integration with secondary and tertiary care. GPs create personalised care and do not need to be incentivised to do this as this is at the heart of being a GP.

Not yet, as a result of difficulties recruiting ARRS staff and their retention due to the funding restrictions based around this. The role of PCNs has expanded significantly and they are becoming accountable for more and more. In the last year they have not had the capacity to support general practice due to the Covid vaccine programme. The ARRS staff do add some value but are in no way replacements for GPs. The ARRS require significant supervision and a lot of the role of GPs has been to provide this supervision to this staff team which either adds to their already busy workload or takes them away from patient care. We need independent practitioners rather than dependent practitioners to provide more valuable support.

GPs are building partnerships across other practices but also across community services. This is a slow evolution that is extremely time consuming and often frustrating. Again, ARRS have had a positive impact but require significant supervision and do not fill all the requirements of general practice. Both retention and recruitment are a significant problems due to funding and available workforce.

December 2021