Written evidence submitted by Dr Fran Killick (FGP0246)

Dear Sir/Madam,

As a GP of nearly 30yrs standing with considerable hospital-based experience before that I feel eligible to comment on GP over many years what is ideal about the partnership model we have now and what needs to change to improve things for GPs and patients alike.

Frankly the system is broken as is hospital access discharge care social care and emergency response. There are simply not enough staff to manage an increasingly demanding population and it is having an appalling and demoralising effect at every level in the NHs. We all understand covid is taking its toll as is the delayed presentations causing consequently sicker patients, hence we are all stepping up to the plate and working in an unprecedented way. Sadly however, this is not sustainable.

Despite incredible adaptations over the last 21 months, GP is struggling, and I agree now is a good time to facilitate positive enduring changes, to enable quality continuity of care from professional respected consultant generalists (ie GPs!) with sufficient time to see and sort patients properly without unnecessary bureaucracy! Surely this is possible and not a pipe dream? I must take an issue that the first time I saw this request for info was today and via a friend. Why was it not advertised more widely? If you get insufficient responses, I urge you to advertise and extend the deadline.

What works?

Small General practices work- working efficiently and cost-effectively utilising lots of different skill sets training the next generation of GPS practice nurses pharmacists paramedics etc and who all buy into the small team model. GP is the most cost-effective model in the NHs if you would but believe it (come and see us in action!) We are ‘lean and mean’ ie no waste& no fat to cut off. This is a wonderful place to be, and serial governments are crushing the life out of it. We at Lawn Medical Centre, are now part of a super-partnership of like-minded GPs which has boosted confidence in GP longevity enough to encourage 5 more partners to join in the last 18m. We are able to maintain our small individual practice hubs and are starting to share at scale to drive up standards, but we are hampered by excess bureaucracy and tick-boxitis making admin now 1/3rd of my day-clearly ridiculous and not sustainable. Also, it is patently clear that neither government policy makers nor NHSE have any idea what good GP is or can be. I am sure there are practices out there that do not manage as well but I really feel clinically excellent cost-effective consultant generalist care is going on out there every day. Who are you listening to that is causing this general destruction of what is best about GP?

What is not working?

1)      Daily, thousands of emails requesting information and that we read multiple paged documents on mostly piffle-all purporting to be part of this gvt initiative or that. Working 13-14hrs days I have no time or head space and so read nothing that does not come in a 1 page format. Why do you assume we do not have a day job?

2)      An all-pervading vitriolic running commentary from predominantly tory-leaning press based on fallacious nonsense printed most days and a weakly supportive gvt that only turns on the pro-GP stance before elections. Do you realise the destruction this is wreaking? Our younger colleagues are turning their back on GP in their droves and going abroad even if they qualify as GPs. Who wants to work as a pariah especially one that has poor work-life balance and causes burn-out? In my opinion this is shoddy poorly-researched journalism, combined with an anti-GP head of NHSE and very poor knowledge-base in gvt policy-makers who appear to have no idea what is really happening in GP or what our job entails or is like-ie what we actually do!

3)      Excess bureaucracy= too many initiatives too many tick boxes so much distraction from dealing with real people and their needs. None of it really drives up standards. I am really passionate about GP I still love it after 30yrs but what is causing my retirement next year, is the lack of quality time I have to spend with my patients doing what I was trained to do and what I do best. Serial governments (ie both flavours as bad as each other) need to take their fingers out of my pie and trust me as an experienced ethical practitioner to do the job I know how to do- I don’t come into parliament or Whitehall to tell you how to do your jobs so why do I get endless nannying? Speaking of which so do teachers and policeman-members of my family would endorse that.

What would help?

1)      Stop all interference and let us shape and mould our practices the way we feel they should be moulded according to local need and demand. Do you wish to consult a GP who spends the entire time ticking boxes whilst you are there about ht wt smoking and what your grandma’s cat died of or give you time and space f2f eye to eye to enable you to feel valued and listened to and divulge painful concerns? As I get older this becomes more relevant to me. We only practise like this (even with admins support) because we have to- no evidence any of this opportunistic info gathering is needed to drive up standards at all. We are self-employed professionals contracting our services to the NHS. Yes we received funding for this, but since when do you tell your heating engineer or solicitor how to manage their business the way you tell me how to do mine? I suspect they would tell you where to shove it.

2)      Allow GPs to decide what percentage of consultations are by telephone, video or email so we can provide better quality, targeted f2f consultations as we are running now. This works well and our patients repeatedly tell us that they like this flexibility, as they do not need to take days off work to see doctor/nurse. WE see any patient that feels they need f2f care and decide the others on the base of clinical need. WE always see the elderly and are still doing home visits. We have never stopped doing this apart from in lock-down 1. We have always been accessible contrary to the slating comments in the press! Unhelpful gvt statements to the press demanding GPs work longer, harder and see more pts simply winds up the general Populus and causes abuse of our staff-thanks. It doubles our workload as we then have to spend extra time reassuring pts on top of seeing them trying to calm them down.

3)      Change the structure of GP. I realise this needs approval from the RCGP but GPs needs to aspire to be consultant generalists on an equal status with hospital consultants. I have several consultant colleagues who are my pts. I know a great deal more than they do about their conditions and they appreciate our cross-specialty knowledge and experience which they do not have! It may be that that would mean trainees train for longer and Practices remain partnerships where GPs all “buy in to the model” only then do you get the same committed care over years and close team “families” being developed which nurture each other and provide continuity of care. Partnership has to be the aspiration and incentivised, salaried status is a stepping stone only and locums only a short term provision for illness/maternity leave etc as it used to be when I joined the practice in 1994.

4)      Enhance the support for GP. When I started the FHSA worked incredibly closely with GPs and were GP centred-they knew their patch and were sensitive and supportive. My goodness what a transformation now. Although our Swindon team (now part of BSW) are uniquely supportive they are unable to buffer us from the negative pressure from NHSE nor can they shelter us from the punitive attitude that pervades most incentive schemes.

5)      Have a GP lead/department in NHSE who could help to develop more appropriate policy and deal in a much more supportive way with GPs. If you treat us like naughty school children, you will get a suitable response.

6)      Allow LMCs to represent GPs at national level ( a statutory change needed I believe) Currently Wessex LMC have represented us well although again their voice is too faint to be heard on the national stage even at national conference I am uncertain they are really listened to.

7)      Support the formation of a GP wing of the BMA. The BMA for all their recent strengths in raising the profile of GP distress and damaging effects of gvt/NHSE policy, does not truly represent GP as distinct from all drs. We are so different from our hospital colleagues that we must be considered a unique case. We are small disparate entities working independently that we are easily divided and conquered. We need a formal voice that truly knows our job from the inside to represent our needs at national level. Gvt may feel this would be a block to imposing policy, but you must be able to see the decimation caused by unilateral GP contract changes and more recent mis-handling of the profession to see that you wont have GP much longer if you carry on with a unilateral model! It was thanks to this heavy handedness under Blair that both recognised it was becoming impossible to cover night on call as well as in the day(good), whilst simultaneously unleashing the press against us and undermining every contract annual review since then(bad)

In balance, please do try to com and actually talk to jobbing GPs  as only when you do that will you really hear what the mood is and understand that the loss of GP will be a devastation that we will never recover from. Once more false step from gvt-(your’s or the next flavour), and you will lose the trainers of tomorrow’s GPs and the profession cannot be resurrected.  I never thought I would see this in my lifetime, and it wont just be my epitaph you will be writing if you do.

 

Yours faithfully

Dr Fran Killick

(Senior Partner, Lawn Medical Centre)

 

Dec 2021