Written evidence submitted by the Group Practice at River Place (FGP0224)

 

  1. Who we are.

We are writing as the Partners of a London GP Practice in Islington, with a list size of 10300 patients.

Between us we have more than 100 years of doctoring experience and in addition, one of us is the Clinical Director of the local PCN.

We are passionate about patient centred care with a well-established usual doctor system and are committed to delivering high quality primary care.

Several of us are GP trainers and all are closely involved in the teaching and training of GP registrars, nurses, pharmacists and medical students.

In so many ways, the last 2 years have been extraordinarily challenging and in common with most of General Practice we have demonstrated the ability to evolve and adapt with the changing priorities.

Along with embracing new technologies, including IT and remote consultations, we have been actively involved in the Covid vaccination program.

We have worked successfully within our PCN on a variety of initiatives.

Despite the current tough times, we are proud to lead a practice that continues to be enthusiastic and energized with a strong shared ethos.

Our views and comments on the future of General Practice are personal and based on reflection and discussion over the last few months.

  1. Partnership 

We believe there are great strengths in the partnership model, which, along with strong leadership, has enabled us to adapt quickly and successfully during the pandemic. The size and scale of our team has meant we could manage and support staff as the nature of their roles evolved. We recognise the economies of scale in the PCN and beyond, but feel there are also advantages in working closely in small teams, which gives us a strong understanding of the skill mix of the individuals within our practice. This has enabled us to develop the strengths within the staff to respond and reach out to our patients and address the needs of our local practice population.

  1. Continuity

From our experience continuity of care is valued by all patients, not only those with long term conditions. We see that it is especially important in managing complex patients, and reducing unnecessary investigations and referrals and therefore keeping costs of care down.

Though some acute and minor problems can be managed by a wider non-GP workforce, patients develop trust in the clinicians that they see regularly and this becomes important when they present with new or more complex illness.

Continuity is also essential educationally as clinicians learn from reviewing patients over time and develop an understanding of the progression of illnesses. Importantly, continuity makes the job more rewarding for staff, as we help and see our patients through their journeys. This in turn helps to build our knowledge and resilience.

We must build on systems that encourage and maintain continuity for patients.

 

 

  1. Remote versus Face-to-Face Consultations

We recognise there is a place for remote consultation, whether by phone, video or online and for telephone triage. This has been necessary to keep patients and staff safe during the pandemic.

Though convenient for some, we do not feel that remote consultation is any sort of substitute for Face-to-Face consultations, especially for the elderly, very young, vulnerable and those with complex conditions. Remote consultation can be inefficient leading to multiple consultation. Also, remotely it is much harder to spot patients hidden agendas. It is easier to promote best evidence-based practice when patients are seen in person and all of the factors, including one’s ‘sixth sense’ as an experienced clinician, can be put into play.

Remote consultations are in danger of reducing General Practice consultations to a transactional process. Both patients and staff alike recognise the importance of the relationship aspect of General Practice, whereby trust built up over years of interactions allows us to help people make sense of the challenges to their wellbeing (both physical and mental). Remote consultations reduce General Practice to a two-dimensional discussion, the vital nuances of non-verbal communication from both patient and clinician are lost: to the detriment of both.

An emphasis on remote consulting appears to be fuelling the demands and expectations of the worried well and inevitably excludes the most vulnerable and the digitally marginalised. At times, lists of telephone appointments can feel that we are working in a call centre rather than offering quality clinical care. Like most of our patients, we feel it is essential to re-establish a service with a greater proportion of Face-to-Face consulting both within primary and secondary care. We are proud that our practice introduced this type of consultation earlier in the pandemic.

 

  1. More GPs

We have welcomed new comers to the workforce in primary care including Pharmacists, Advanced Clinical Practitioners and Social Prescribers, and have seen that they have brought their own particular skills to our Practice team.

Although there have been many benefits, those working in these additional roles require considerable supervision and support to enable them to work independently and help with the escalating patient demands. GPs have taken on this supervisory role which is rewarding but it is also time consuming taking us away from direct patient care.

We continue to need more GPs with their unique set of skills in diagnosis and management and are able to see patients efficiently and safely. GPs take many years to train which is expensive, but their skill set with an increasingly complex elderly population cannot be replaced easily by others.

 

  1. Resilience

The last few years have been difficult and stressful with the pandemic bringing particular challenges. One of the joys of being a GP is working in a team of like-minded people all focussed on delivering quality patient care. At the heart of this is the doctor/patient consultation and it is through this often complex interaction that we are able to understand and address the needs of our patients. Experience has taught us that we learn from the narrative of our patients along with advise and support from our colleagues. One initiative that we are particularly proud of is that we have established a comprehensive well-being program within the Practice. We have found that this has enriched us all and helped the team thrive. While embracing new ways of working we must explore the evidence behind new models of care. It is essential that we preserve the core values of the ‘traditional General Practice as this contributes hugely to our job satisfaction and resilience. Unless we take these factors into account, we will not be able to attract new doctors or other staff into primary Care or indeed take on the responsibility of becoming a partnered GP.

 

 

The Partners of the Group Practice at River Place

 

December 2021