Written evidence submitted by Mr Paul Carroll (FGP0225)

My Evidence:

• What are the main barriers to accessing general practice and how can these be tackled?
• In my experience the barriers are the current overwhelming demand across the NHS and Social Care , have created tensions and frustrations. Explained further
• Social Care- underfunded and understaffed- unable to give much more then skeleton coverage
• Ambulances- major delays in cover- root cause Accident and Emergency departments overwhelmed- causing queues of many hours for ambulance
• Insufficient Nursing Staff- very hard to recruit and retain
• Insufficient numbers of doctors- no real progress on recruitment targets, leaving GPs retirement brought forwards or going part time, to protect their own health.
• NHS cannot say no, it is truly open for all , which includes many patients who are a revolving door , without any true diagnosis or treatment plans.
• Massive underinvestment in mental health support, leading to multiple presentations to primary care.
• Low staffing numbers of district and community nurses- reflects years of cuts and underinvestment.
• Low wages for salaried staff given the day to day pressures that they face.

Suggestions of how to improve

• A comprehensive and funded investment in nursing.
• Increases in global sum payments to allow more salaried staff to be employed.
• Adoption of an agreed triage model, used by primary and secondary care, so freeing up appointments for those with the greatest need.
• Ramp up the urgency to invest in nurses and doctors- so enabling a service at a Primary Care Network level which operates 12 hours per day and at least 0.5 day of a weekend.  This would be a massive commitment to resourcing needed, I accept.  But capacity is the largest barrier to be tackled.
• Alternatives, rather than the present model of constantly seeing those patients who make frequent demands, without any clinical need. Clear patient plans for those patients who frequently attend without any clinically defined real need (accepting this is often contrary to patient perception). Standards and expectations of how to manage this cohort of patients, but still retain their dignity and ensures safety netting is a skill which needs to be trained and patients supported with the options open to them (example working with other professionals within the PCN- as an example, the social prescribing link worker).
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• To what extent does the Government and NHS England’s plan for improving access for patients and supporting general practice address these barriers?

• The messaging form Government has been very inconsistent.  Wanting a triage model, then after a triage model implemented, then rubbishing the notion and pushing a face2face agenda. Totally confusing messaging from central government, I am afraid.

• What are the impacts when patients are unable to access general practice using their preferred method?
• This does concern me greatly. We need further investment in IT, correct coding (to identify vulnerability) and an ability to offer services on a level playing field to all.  The present model lends to those who have a good clear voice, or a good advocate.  This for me is a key part of the levelling up agenda.  I have concerns for the patient who is anxious and ringing or visiting the GP is a big deal.  When they call or present if we cannot support them, at that very moment in time, there is a chance they may never come to discuss their health concern.

• 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?
• Working with a model where my doctors always ask if possible to see the patient matched with their usual GP creates better continuity and working relationships.  When it comes to key decisions about interventions or referrals, end of life care, this aspect of the relationship is essential to good quality care, in my opinion.

• What are the main challenges facing general practice in the next 5 years?
• Uncertainty about the model of general practice, how will PCNS develop?  Please do not rush to  replace PCNs with a new model, they need a chance to grow and find their place within the new ICS model
• IT is aging and there does not seem to be the funds centrally to invest in a new clinical notes platform.
• Commissioning intentions are very unclear within the new ICS/PCN model, with the dissolution of the CCGs.
• Locum GPs are of very varying qualities, and too expensive to hire on a very regular basis.
• GP morale is very low caused by (a) overwork (b) feeling very undervalued by recent media campaigns attacking the GPs for not being able to offer enough Face2Face appointments according to certain media outlets (c) uncertainty about future working models/funding/future of the GP Partnership model.
• How does regional variation shape the challenges facing general practice in different parts of England, including rural areas?
• GPs are very strong at being able to adapt , as they are rooted in their communities.  A levelling up committee, I suggest could take this question as a separate action.
• What part should general practice play in the prevention agenda?
• Unable to give quality evidence here, other than the  training element.
• What can be done to reduce bureaucracy and burnout, and improve morale, in general practice?
• Key messaging being positive and supportive from NHS E and Government.
• Working via NHS I, to stop unnecessary tasks ( a systems thinking issue here).
• More nurses, and doctors to manage the ever increasing clinical and non- clinical workload.
• Greater budget via increased global sum to be able to raise salaried staff salaries and employ more non- clinical staff.
• 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?
• I genuinely think, yes, subject to further investments, assistance with building costs, top notch IT that runs fast and has a very low downtime.  IT running slow/downtime only means partners working longer /harder to cover these deficiencies.  With a belief from Government in the GP partnership model and investment, the model does remain sustainable. GPs hold the patient care from cradle to grave, undertake 90% of NHS contacts, are part of the community, have a high level of trust in the community, take a pride in the GP Partnership model, only refer patients to secondary care as necessary, and consistently work above and beyond.  That is a model worth retaining and investing in, I wholly believe and submit to this committee.
• Do the current contracting and payment systems in general practice encourage proactive, personalised, coordinated and integrated care?
• Yes, if the contract is right, and explained in simple terms.
• Has the development of Primary Care Networks improved the delivery of proactive, personalised, coordinated and integrated care and reduced the administrative burden on GPs?
• This is still very early days. The ARRS roles are now coming on board and need a chance to be embedded.  Too early to comment really.
• 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?
• PCNs have developed with a core group of GPs and Practice Managers, in my experience. Again it is just too early to give any objective evidence on this issue.  Early experiences are developing new relationships and trust- key to collaborations and shaping the future of care locally.

Kind regards

Paul Carroll

Practice Manager for 5 years and over 35 years service in the public sector.

December 2021