Written evidence submitted by Dr Imogen Staveley (FGP0211)


I am a salaried GP in North Warwickshire.  I work part time in an urban practice with ~20,000 patients.  Most of my patients are from a low socio-economic background.  I felt passionate to submit evidence because I care deeply about my patients and want to sustain a high-quality general practice which is free to access and which strives to reduce health inequalities.

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

Barriers to access:

How can barriers be tackled:

To what extent does the Government and NHS England’s plan for improving access for patients and supporting general practice address these barriers?

What are the impacts when patients are unable to access general practice using their preferred method?

What role does having a named GP—and being able to see that GP—play in providing patients with the continuity of care they need?

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

  1. Workforce recruitment and retention
  2. Patient expectations – general practice must deal with ‘wants’ as well as ‘needs’
  3. Estates – primary care estates not suitable for modern needs
  4. Must find a voice in integrated care systems
  5. Making the most of primary care networks
  6. IT – not only is technology outdated but the support around it is very poor in many areas of the country
  7. The new generation of GPs are choosing to work differently, and this requires re-thinking of how general practice moves forward
  8. Patients’ needs are changing, patients are ever more complex, and many have co-existing mental and physical health problems
  9. Balancing providing an acute service with prevention and managing complex patients
  10. Balancing general practice with taking part in the COVID vaccination campaign

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

Regions do vary.  Therefore, support for localised approaches is key.  Integrated care boards (ICBs) must set strategy but support a bottom-up place-based approach in the main.  ICBs must have reducing health inequalities core to their strategy.


What part should general practice play in the prevention agenda?

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

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

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

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

In a word no!  The NHS should be using outcome-based contracts and value-based commissioning.  We need to segment the population and work collectively across organisational boundaries in each integrated care systemTo achieve this the NHS needs ambition and sensitivity.

One of the barriers to this is that it is easier to track process measures than outcomes measures because outcome measures have many factors impacting on them and in some cases cannot be measured for years after the intervention was made. However, we cannot use this as an excuse for evermore because we do have proxies we can use and research is helping us work out the best of those to use.  Outcomes Based Healthcare https://outcomesbasedhealthcare.com/ is pioneering in this regard.

Many more people need training in values-based healthcare.  It is crucial for our patients that we embrace this now. 

Furthermore, clinicians must be involved in choosing measures linked to contracts.  In the past, QOF markers have directly gone against the most up to date guidance on how to manage patients which is at best frustrating and at worst dangerous.  One example of this was around atrial fibrillation management – practices were incentivised for prescribing aspirin long after it was clear this was poor practice.  

Along with payment, practices also need tools to enable them to monitor outcomes effectively and support segmentation.  They also need to be supported to work with others in their PCN and ICS on this – they cannot work in a silo to be effective. 

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

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

December 2021