Written evidence submitted by St Mary’s Surgery (FGP0240)

To Rt Hon Jeremy Hunt MP,

We at St Mary’s Surgery, a small, semi rural practice in Timsbury, Bath, would like to submit our response to the Inquiry into General Practice.

What are the main barriers to accessing general practice and how can these be tackled?

Demand currently outstrips safe provision due to inadequate numbers of GPs to provide the necessary telephone and face to face consultations. This is compounded by support staff absence and loss due to being treated poorly and suffering work stress due to hostility from patients. This in turn has been fuelled by a toxic media which raises patient expectations whilst simultaneously denigrating NHS staff for their efforts. This has been compounded by the limitations of working in a pandemic.

GP time is further taken away from patient care by supervising allied health professional roles which have not been adequately thought through or funded.

We need adequate investment into the NHS and for it to be run by an independent body that is not subject to the vagaries of a political cycle. Repeated and sustained political interference into structures and systems within the NHS makes it impossible for the service to grow.

To what extent does the Government and NHS England’s plan for improving access for patients and supporting general practice address these barriers?

We are not aware of what the Government and NHS Englands plans are for improving access. We sincerely hope that they involve training and funding more GPs and adequate funding for secondary care and social care so that the system can function.

What are the impacts when patients are unable to access general practice using their preferred method?

Delayed diagnoses with potential for poorer health outcomes and lengthier and more expensive treatments. Increase in patient anxiety and stress, with prolonged suffering. Patients access other services e.g. ED inappropriately, and there is an increase in complaints and abuse to hardworking staff.

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?

Continuity of care is evidenced based to provide better health outcomes and increased patient satisfaction. Having a named GP is an important part of the solution to providing continuity of care. However, there are other factors that also impact on continuity. Enhancing continuity should be the focus of any change to the system as it stands

What are the main challenges facing general practice in the next 5 years?

Rising demand and costs, recruitment and retainment of staff (especially clinical), excessive and dangerous workloads for GP’ are all significant problems, but probably the greatest threat to General Practice (and the wider NHS) in the next 5 years is the prospect of a government that fails to invest in, and take responsibility for, the success of the NHS. Continued efforts to erode trust in General Practice by certain sections of the media and politicians will reduce the supply of new doctors wishing to enter primary care. Long-term policies that shift the nation’s institutions into the private sector undermines the ethos of the NHS and adds additional unhelpful bureaucracy, destroys continuity of care and demoralises staff. A constant cycle of reorganisation of the NHS at every level depletes rather than improves the service.

How does regional variation shape the challenges facing general practice in different parts of England, including rural areas?

Our practice is semi-rural. There is little or no public transport for people to use to get to appointments.  We have a high number of care homes which require a great deal of support. There is the threat of new housing developments with very little increase in local resources to match the population increase. Dispensing income is crucial to our ongoing survival, as other sources are inadequate.

What part should general practice play in the prevention agenda?

General practice is well placed to play a significant role in the prevention agenda, but can only do so if funding is re-focused in general practice. We need more resource and support from public health at a neighbourhood level to focus on population health management and inequalities, early intervention and addressing the wider determinants of health.

What can be done to reduce bureaucracy and burnout, and improve morale, in general practice?

There has been a sustained expansion of the GP’s role in management of funding streams eg PCNs, QOF without adequate resourcing for their time. Referral processes are too complex and choice is a distraction. Bids for small pots of non- recurrent funding are seldom helpful and also time consuming to manage, but devolved budgets with a few key outcome performance  measures are better Guidance keeps changing and it is very hard to keep up with it.  Primary care is over regulated and professionals need to be given more autonomy to do the right thing for those they care for.

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?

The traditional partnership model has many advantages and makes best use of the diversity amongst GP’s who on the whole are a resourceful and highly dedicated group who thrive with autonomy. However, given all the other pressures on the system, the current model of unlimited liability is completely unattractive and is putting further pressure on those taking responsibility and holding up general practice in a highly challenging environment. If limited liability is not removed, we will not be able to recruit new partners into the future.

Do the current contracting and payment systems in general practice encourage proactive, personalised, coordinated and integrated care?

No. These are not fit for purpose. Systems are complex and confusing, not aligned with other parts of the system and do not reflect actual work done. Primary care has insufficient resource allocation and much of the money for the NHS never reaches the frontline.

Has the development of Primary Care Networks improved the delivery of proactive, personalised, coordinated and integrated care and reduced the administrative burden on GPs?

In principal PCN’s are excellent, and have functioned well and enable us to be responsive to the pandemic in a way that would have been far more difficult had they not existed. However, they are not currently sustainable, as they require time investments to succeed, and this has been inadequately funded. They will fail if the time required to run them is not funded, as goodwill is almost out.

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?

General practice always strives to be an effective partner for the benefit of our patients, this includes working with secondary care and the social sector as well as allied health professionals. However, partnerships with clinical pharmacists, physiotherapists etc all require supervision and oversight which needs to be funded to succeed and not increase the drain on GP time.

Dec 2021