Written evidence submitted by Dr Crutchfield (FGP0207)

I am a salaried GP in my 4th year of practicing following completion of my GP training. I work in a rural practice with 28 000 patients.

1)      What are the main barriers to accessing general practice and how can these be tackled?


Staff shortages – focus on retaining staff not just recruiting. Tempting people with the idea of being a ‘portfolio’ GP may work for some people who want to develop special interests. However, we need to focus or making the day-to-day work of GPs bearable so we have enough people doing enough ‘standard’ GP sessions.


Managing patient expectations – we do not have enough GPs for all patients to expect to see their named GP. Partners at my practice have 4000 patients each. I think GPs should be seen on par with hospital consultants. We can see the most complex patients and supervise and support nurse practitioners, paramedical practitioners etc. The patients need to understand that they are highly qualified practitioners and capable of fully assessing patients in primary care, with GPs available for advice. GPs are expert generalists – with so much multimorbidity the population needs people who can provide a holistic health assessment and not just focus or one bodily system.


Remote consulting works well to increase access for people who are working and find it difficult to get time to visit the GP. However, this needs to be supported by adequate staffing – so as not to just create extra demand such as that created by e-consults. Care needs to be taken not to disadvantage patients who cannot use technology to access general practice. In my rural practice area, many patients struggle to access telephone consultations because mobile phone coverage is inadequate.


More widely – investing in public health would reduce multimorbidity due to lifestyle factors such as smoking and obesity, which would reduce pressure on primary care and they whole of the NHS in the long term.


I do not think that the governments plan currently addresses any of these issues sufficiently.


If patients cannot access general practice, they either present to other services such as A&E, or their health may be left to deteriorate.


2)      What are the main challenges facing general practice in the next 5 years?

    1. Staff shortages
    2. Shortage of GP partners and possible collapse of businesses
    3. Multimorbidity; particularly that created by obesity


3)      How does regional variation shape the challenges facing general practice in different parts of England, including rural areas?


I work in a rural area, many patients do not have sufficient mobile coverage or internet coverage to access General Practice remotely. Lack of public transport means some patients must pay for taxis to get to the surgery.


4)      What part should general practice play in the prevention agenda?


GPs are well placed to encourage individuals to make lifestyle changes with the support of lifestyle coaches to provide more follow up, which GPs do not have time for. However there needs to be investment in prevention outside of the health services, especially with obesity; increasing access to exercise and green spaces; regulation of the food industry; and education, starting with school children.


5)      What can be done to reduce bureaucracy and burnout, and improve morale, in general practice?


GPs need to be respected on a par with hospital consultants, and our role as expert generalists acknowledged. Manage patient demand – patients are no longer happy to wait 2 weeks for a routine appointment even when this is clinically appropriate.


6)      How can the current model of general practice be improved to make it more sustainable in the long term?


Is the traditional partnership model in general practice sustainable given recruitment challenges, the prioritisation of integrated care and the shift towards salaried GP posts?

I do not believe so. I am a salaried GP and I have seen the level of risk the partners have had to manage in the past year. When they cannot recruit, they must take on the extra work themselves, and I think the current workload risks patient safety. I personally find managing clinical risk difficult enough and would not want to have to manage the risk of being self-employed without much greater Government support.


Do the current contracting and payment systems in general practice encourage proactive, personalised, coordinated and integrated care?

The current payment systems to not provide enough money to care for patients with multimorbidity. We need longer appointments and therefore more staff.


Has the development of Primary Care Networks improved the delivery or proactive, personalised, coordinated and integrated care and reduced the administrative burden on GPs?

Through our primary care network we have been able to recruit some first contact physiotherapists and mental health practitioners, although we could have done this without the PCN if the funding had been allocated to the practice. We have 28 000 patients so we only have one other practice in our PCN. I think the primary care networks have increased administrative burden.


To what extent has general practice been able to work in effective partnerships with other professions with primary care and beyond to free more GP time for patient care?

At the start of the pandemic there was hope for better communication with secondary care. However this has not happened. With hospital consultants doing remote consulting, primary care has to do extra prescriptions and physical checks such as blood tests and blood pressure readings which would otherwise been done at their hospital appointment. Whilst this can sometimes work well for patients who do not have to travel, this extra work needs to be adequately resourced and funded. We are increasingly having appointments taken up by patients who are waiting to be seen in secondary care, having already done everything we could for them in primary care. The hospitals need to manage patients on their waiting list and patients should not be asked to contact general practice unless their condition deteriorates.

December 2021