Written evidence submitted by Dr Helen Speakman (FGP0231)

 

I am sending this as a 50 something female GP who is now a partner but has worked as a salaried GP, and I believe general practice is very precious to our society and nation and should not be destroyed.

We need to protect General practice to encourage young GPs to stay within it mainly as partners with their passion for caring for our communities

 

 

What are the main barriers to accessing General practice

 

The main barriers to accessing general practice is the lack of appointments to see GPs or the other members of the GPs team-this is due to :

A lack of doctors

As lack of nurses/ nurse practitioners

And well qualified reception staff

 

The impact when patients are unable to access general practice using their preferred method is:

Patient dissatisfaction and complaints;

Having to use other appts eg IAGPs appointments which the patient often finds unsatisfactory, and then re attend to their own GP, thereby duplicating some appointments;

The risk of illness worsening;

Using other methods like e consult, which I believe most GPs find unsatisfactory, and is another work stream for GPs for which there is no a proper ‘place’ in their working day;

Patients choosing other routes of help such as calling 111 when they should wait for access to their own GP; or 999, or attending A&E.

 

I think having personal lists or having a named GP that knows the patient- especially in chronic illness or complex illnesses or multiple morbidities- has always been important & is even more essential now that more people are involved in the GP team. We are becoming the senior clinician/conductor. So we need to know our patients. But therefore , we also need time to attend to their complex needs.

GPs carry risk a lot, we know when its not appropriate to continue to investigate or admit as it would not be in a frail persons interest, we can have those conversations with patients when we have time, compared with other practitioners who are protocol driven or risk averse and then they will admit.

Knowing your patients and the family makes a big difference to care and these sort of consultations

It’s noticeable we are being asked to work with other member on the assumption that it frees up our time. It can be helpful, but these other members of the team need supervision.

With secondary care doing less complex multi morbidity work and more care being pushed into primary care we are overworked, making it difficult to find time to assess these complex cases. Post pandemic secondary care a closing their lists, breaching their times and patients therefore come back to us for support and we are the single part of the profession that remains available ( and goes home late)

We are contactable by all these parts of the integrated team by the click of a ‘task’ into our in box, that person then offloading their concern onto the GP but not giving us any extra time to deal with these concerns.

GPs are often running parallel ‘surgeries’-booked appointments, tasks with queries, e consults, and acute text replies.

 

Secondary care has turned in to single process ‘technicians, eg a gastroenterological problem- they do a gastroscope and discharge back to us saying re-refer if ongoing concerns, but there is now rarely a pre-test consultation with a doctor, or a post test consultation about whether they should be considering an alternative diagnosis or further tests. So this work falls on general practice , also if the GP does not know the patient well following what is going on means the pathway of diagnosis and review is less satisfactory or more risky for the patient

 

 

 

General practice has always played a role in prevention, and will continue to do so, supported by some other organisations-eg smoke stop, live well, health coaches. But where is the public health funding? Where is the political will to change inequality in health across our nation, by tackling life and health inequalities?

 

 

Please stop the political GP bashing- we have given the Conservative government their vaccination programme success, and you are still expecting us to give even more.

Stop the media bashing of GPs. It erodes the trust of our patients in us.

Please acknowledge the amount of unrecognised/‘unpaid’ hours we work in our own time: Catching up with our ‘paperwork; making plans to run our practices/pcns; our personal learning and updating as the covid pandemic evolves. We are professionals and expect that this work comes with the territory, but give us the respect we deserve as partners. Otherwise Young GPs will not take on this work and general practice will collapse, as it is based on good will ( like GPs doing on call was before out of hours was brought in). Primary care can’t work based on salaried GPs. Then the government will find out the true cost of primary care.

To reduce bureaucracy :reduce QOF, get rid of/reduce appraisal), stop making us jump through more hoops for payment- trust us to use monies wisely for our communities

 

It could be sustainable if the government wasn’t trying to destroy the model, thereby making the next generation of doctors nervous of buying in and committing their own money to the business. Also the new generation have to commit to the ethos of a professional lifetime commitment, and this only works if they see stability and respect . In general practice and in other specialties the government has to realise that now more women work in general practice we need more doctors to be trained as the old model of the white male doctor working long hours with a stay at home wife supporting him and his practice is no longer the case, and a part time doctor is equivalent to most other full time jobs. So we need many more doctors as many will be working less than 10 sessions a week.

Salaried posts are acceptable but need to remain the other option rather then the main model of primary care

 

It has helped the delivery of coordinated and integrated care, and has perhaps helped prevent more more burnout as there are more members in the team to help GPs. The pcn pharmacy technicians have removed some of the administrative burden.

We are contactable by all these parts of the integrated team  by the click of a ‘task’ into our in box, that person then offloading their concern onto the GP but not giving us any extra time to deal with these concerns.

GPs are often running parallel ‘surgeries’-booked appointments, tasks with queries, e consults, and acute text replies.So none of these has helped reduce our administrative burden.

 

 

Within pcns we have been able to work in partnerships, it is hard to perceive the ‘free time’ it has created as we are busy delivering flu clinics, covid vaccines, and catching up with over due reviews/QOF work and seeing patients with concerns that they have hung back with, during the pandemic, so we only feel very busy.