Written evidence submitted by Bradford on Avon and Melksham Health Partnership (FGP0221)

Access

Important to point out that no GP practice wishes barriers to appropriate access.

Primary care remains committed to providing high quality care, by the right professional at the right time.

Investment in better cloud-based technology for phone systems and investment in care navigators is key.  Patients need to be educated on the value of good care navigation and get rid of the outdated view of ‘being fobbed off by a receptionist’

Allow practices to be innovative as they know their demographic and what works for them. Get rid of online access targets. Practice want to engage with this but not at the expense of the personal approach to those who want it.

Empower and allow secondary care and other providers to initiate and prescribe for patients by using EPS to their local pharmacies. Inform primary care but this double handling is inefficient and uses up capacity.

Challenges

Patients seen in primary care more complex with co-morbidities.

Allow practices to build up MDT approach to chronic disease- which is happening to some extent- but educate our patients that they will be cared for a by a team rather than an individual but with their named GP having prime responsibility.  No-one expects to see the consultant every time they have a secondary care outpatient appt. – This should be the same for primary care.

Secondary care are planning to cut outpatient activity significantly. This is concerning to primary care who may be left to organise additional investigations and liaise with the patient. Ensure process in case to ensure this workload is not just transferred to primary care.

Estate challenges: many practices including ours is bursting at the seams., We have no more room to put anyone. This is concerning in terms of educating our future primary care professionals and housing the increasing PCN workforce.

Prevention agenda

Prevention has and always will be important in primary care, but in view of rising demands and workloads we are forced to concentrate on providing an ‘illness service’ .  healthy hubs based in our communities with close links to practices could provide this role.

Burnout and morale

It has been welcomed that there has been support offered both locally and nationally however none of this solves the problems.

National bodies must come together (BMA/NHSE/government) and clearly define workload for primary care, Including core and non -core work as there appears to be much national variability. This can then for a baseline for core funding and adequately resource practices for providing additional services/.

Practice must be free to be innovative and be trusted with public funding to enhance local care.

Fund practices adequately to appropriately remunerate hard working back-office teams and make them more efficient.

Stop campaigns to slur hard working professionals in the media and stop blaming primary care for the problems faced in our A+ES. Accept that the whole system is overloaded.  What we have seen in the last 6 months has probably reached the threshold for organisational bullying and is unacceptable.

Develop a national agenda so that patients understand what primary care can offer. Stop primary care being the ‘dumping ground’ for anything where other services are stretched or unavailable

Sustainability and partnership model

General practice must be sustainable as the NHS continues to need the gate-keeper role.  Working on burnout and morale issues will improve this.

Partnership encourages high standards of care and allows practice to truly provide a local and patient centred service. General practice excels when its diversity is kept. Allow GPs to be entrepreneurial.  It is the partnership model which allowed GPs to act swiftly and at scale to the pandemic crisis, making their own decisions for their own staff.

NHSE needs to support practices more with premises and reduce the fear of ‘last man standing’ This will encourage more GPs into partnership which I believe leads to a quality service.

Contracting and payment systems

Current systems are over bureaucratic and complex and of poor quality.  Practices are wasting precious resources chasing unmade payments from PSCE, which is difficult to do without escalating to a complaint.

These systems force primary care into a ‘box- ticking approach ‘ and is at is stands a disincentive to provide truly local services.

Practices should be free to provide services they feel are most important to their patients, at an appropriate time by the most appropriate practitioner.

PCNS

PCNs have increased the administrative burdens on practices and has reduced face to face clinical time. The addition of AARS staff funding has been welcomed however has increased personal liability and risk to partners. There is uncertainty about legal aspects of these organisations. This may be a dis-incentive to attracting new partners.

It is unfair that the only way practices can access these funds are being forced to work with other practices who may not share the same values, have very diverse populations and requirements.

Partnerships feel they are blackmailed into ‘merging’ as no other choice to obtain funding

December 2021