Written evidence submitted by Anonymous (FGP0229)

 

1)      Online total triage.

2)      Appointments being taken up with patients using the services inappropriately. The govt and press have told patients that they should be able to access the limited resource of professional GP input for whatever and whenever they want, anything less if now deemed a failure of GPs (we are implicated as being greedy lazy individuals when in reality we working 12-14 hour days without breaks making important decisions on a minute by minute basis for most of the working day – doing all our professional, educational and business  work outside of these hours ) We are referred to a being part-time even though we are doing 40-52 hours a week of work ( only 3 surgery patient facing days) – nurses doing these hours would not be referred to as being part time and airline pilots would not be considered safe doing these hours – the working conditions are currently appalling, toxic resulting in burnout. This is highly irresponsible of the government and the press. This sense of entitlement has resulted in the breakdown of patient trust in GPs. This impossible and, at times, inappropriate workload coming through online requests/e-consults is not an efficient or effective way to consult in most situations. Dialogue is the essence of communication and communication is the essence of General Practice. Without dialogue and good communication, a GP cannot truly assess the patient’s health needs, ‘know’ their patients, monitor their health and wellbeing, pick up on subtle changes early in an illness, preventing deterioration. I propose that any health need request that can genuinely, safely and thoroughly be met by an e-consult should be provided by a stand-alone service (such as NHS 111) This would mean they were not wasting our precious time, experience and skills, freeing us up to be able to speak to and see our patients. NHS 111 was initially supposed to provide healthcare but is now seems to be just a very expensive signposting service. Much of it may as well be done by a chat box since the staff are limited to flow charts and are not allowed to use any clinical training, skills or autonomy to actually help patients independently according to their needs.

3)      Workforce crisis – not enough doctors join general practice and another mass exodus about to start with doctors being so burnout they are unable to continue doing the job ( even though they had previously wanted and planned to work to retirement age) This has been affected by (i) patient workload (ii) funding and support not commensurate with patient needs (iii) financial/business commitment required for the current partnership model (iv) GP has become a lonely job with enormous  burden of responsibility: professional, regulatory, contractual, financial and including full employment law responsibilities for its staff/workforce.

4)      Restrictions due to inadequate premises.

 

The govt imposing total triage onto general practice and making online access a contractual duty instantly destroyed the ability of patients to access our service by a method of their preferred choice. You turned our services into a walk-in centre with no respect for the previous model, our patients needs or the work we do. Online requests come in faster and more numerous in volume (but not necessarily need) clogging up our systems, workload and preventing the old, the frail, the illiterate, those with language barriers, the less internet connected and the poor from having equal access to our services. This was not our doing but your contractual doing. Online access to GPs should be ceased forthwith to reset equal access according to need and not according to internet access. Essential, important and urgent work comes in by phone after we have already reached safe capacity giving our receptionists less to offer our patients at their time of need, frustrating both patients and reception alike. This makes the job of being a receptionist less rewarding and more stressful. These are people who chose to work in health care to help our patients and they previously used to enjoy their work, fixing things for our patients. You have destroyed that with online total triage. Patients who cannot access care cannot receive care.

 

 

Having a ‘named GP’ imposed on patients by the govt is purely an additional and bureaucratic exercise that completely ignores how we work and undermines our professionalism. It is meaningless to patients and the true care a patient gets depends purely on how a practice chose to organise its services. GPs want to see their own regular patients; we advocate continuity of care as it facilitates good care, and we want our patients to get the best care we can offer. Patients get better care and GPs give better care (and have better job satisfaction) when they know  their patients. In my surgery we allow patients to choose their GP and we encourage them to stay with one doctor where possible. The ‘allocated named doctor’ is an irrelevant requirement made by the govt.

 

 

Predictable challenges for the next 5 years (many of these are not even new challenges):

1)      Growing demand from an aging population and increasing number of complex patients with complex needs and therapeutic regimens.

2)      General Practice having to carry the patients failing to get the 2ary care they should have received but have not due to the waiting times that exist – all much worse now due to covid and the ongoing cost of collateral damage to our NHS.

3)      Shrinking workforce of trained GPs – less joining and many more leaving of all ages, not just those over 50.

4)      Premises not fit for purpose.

5)      Funding not fit for development and not commensurate with the work we do in protecting our patients from ill health, keeping them well, active, controlling their symptoms and keeping them out of hospital. The govt seem to have no idea about health economics and how cost effective we are for our patients. The govt will spend far more on community pharmacy appointments, UTC attendance, A&E attendance and get so much less for each pound spent. These additional services are welcome and needed but there is no equity in funding. We are a Cinderella and now much berated service.

6)      Clinical records have become less useful/efficient due to e-consults and multiple professional involvement reducing the safety of care giving - the more data on the records the more ‘noise’ on the records – our previous clinical records were written by us for us and our management plans. These have been hijacked by numerous ports of entry and access and there will be accidental harm done to patients as a result of this data ‘noise’.

7)      GP partnership model is outdated and unfair.

 

 

 

 

Re prevention – you have no understanding of what we do in every consultation by even asking us what part we should play in prevention. It is already at our core. We serve our patients in every way to keep them well and prevent them getting ill and suffering, but as you cannot measure that you do not seem to acknowledge it. This has been a problem ever since the 2004 new contract. I think it was unnecessary and unwise to separate out some funding to public health and politicise it further at a local level. All the big wins in health improvements historically have been made by good law supporting good public health measures not by small local changes and postcode lottery care. Successive governments have continued to fail to address our nations health. Obesity is a disease of rich nations who will not feed themselves properly, a disease of excess and poor choices not poverty. We have a massive workforce crisis currently and yet we produce large amount of processed unnecessary unhealthy food contributing to obesity and landfill. Toxic to humans and the environment together. A brave govt would tax processed food out of existence (or at least into luxury item status) and the workforce could then move across to do more community spirited, sustainable and possibly even rewarding jobs, filling essential vacancies and professions needed to keep our infrastructure going. Our society and nation are struggling and sick. They need help getting out of this vicious cycle, a society which will continue to be in terminal decline (despite what we do as individual doctors) unless a strong govt helps them change.

 

 

Bureaucracy – give us a long-term contract not an annual contract with annual moving targets. These serve only to give your bureaucrats more work and our teams more work, reducing all our resources and productivity at great cost. By being brave and bold with our contract you could make some good savings and remove/ reduce the politics from health care. CQC can then start to chase meaningful clinical targets rather than their sole-destroying process driven targets which do no improve health care and serve only to increase the bureaucracy and administrative burden in surgeries. CQC also currently contributes enormously to the emotional cost to our care givers of all persuasions directly resulting in so many of them leaving their chosen careers prematurely.

Burnout – reverse you wrongheaded disrespectful change turning us, our service and our business into a walk-in centre, via your total triage imposition, yet expect us to continue doing all the things we do for our patients and their families. Lack of job satisfaction contributes to burnout and becoming overworked call centre doctors without time for a break (as we have become by your total triage process) is not what we chose and is directly resulting in more doctors and nurses leaving the profession prematurely.

We are the only professional independent advocate for all our patients needs. We are holistic in our approach and do actually provide health care, as well as help to navigate our patients’ way through our complex health service as best we can. Sadly, we are often having to also guide them to use PALS to help then get what they need from secondary care, when all our professional efforts with secondary care fail them still.

I fear then damage you and the press have done to many of our current GPs is already irreversible. You have not shown respect for our work, support for our services or protection for our workforce.

I suggest that you cancel appraisals and revalidation. We are professionals and you seem not to understand what being a professional actually means. We have already proved ourselves during our long training/apprenticeship under supervision of teams of other professionals and all the professional exams that we have taken. We work to our GMC standards in four domains:

You should remove revalidation from those over 55 years old because it is an additional and unnecessary burden that is contributing to GPs leaving the profession before their time, caused by govt.

Improve morale in General Practice – respect GPs decisions for their patients and the business of general practice. They are all doing everything they can, not for themselves, but, for their patients. You removed seniority payments and no longer financially reward doctors for their experience, skills and longevity of service.

 

 

 

Many of those who have trained as GPs do not wish to enter into partnerships due to the cost and responsibilities that these additional roles entail offering very little, if anything,  in return. The way forward is salaried service combining clinical freedom with a professional wage and additional payments according to a combination of workload (patient contacts, vulnerabilities, disease prevalence and updated Carr-Hill formula) patient outcomes (value added measures in terms of mental and physical wellbeing) and patient satisfaction (but this has to be in the context of a safe and fair patient-clinician ratio) and innovation.

 

 

Your contracting and payment systems have improved only some measurable parts of our work, improving proactive care (or the measuring of it). They have done nothing for personalised, coordinated or integrated care, which are in fact meaningless terms in this context.

 

 

PCNs will, in time, hopefully be able to help reduce the administrative burden on GPs. It was the govt who made every surgery spare a clinical GPs to participate in CCGs and Clinical governance and PCNs, taking them aware from their essential clinical work and thinking nothing would ‘give’ and that patients would not lose out. It was the govt who has required an army of GPs to provide nonclinical work such as appraisals, revalidation and CQC inspections, again taking them away from the job that they are needed for, that they are trained to do, that they are skilled and expert in and that the population needs. We could all see how unnecessary and stressful these poor decisions made by govt were, yet you do not listen to us or look at the big picture.

 

I hold the government fully responsible for the destruction of a previously brilliant and highly effective primary care service. A career brilliantly clever, caring, innovative and committed individuals once wanted to join, but no longer. The govt and press surprisingly seem to want to hold GPs to account for the fallout of previous poor govt impositions on our profession and our businesses. The sooner govt get out of healthcare the better.

I challenge you to make some wise decisions.

Dec 2021