Written evidence submitted by Dr Julia Darko (FGP0248)

 

UK Parliament Health and Social Care Committee Inquiry December 2021: The future of General Practice

 

Evidence submission from the King’s College General Practice Vocational Training Scheme 2021

 

Who we are:

 

The King’s College General Practice Vocational Training Scheme is a group of doctors undertaking the General Practice specialty training scheme based in and around King’s College Hospital in Denmark Hill, South East London. We are a group of over 40 doctors who have chosen to pursue a specialist career in General Practice and are completing our training towards full accreditation as General Practioners. As such, we are and will be for years to come the GPs at the centre of any change or reform to General Practice in the UK. We are dedicated to providing a high standard of primary care to the patients and communities we serve. We are determined to work in a system that is effective as well as efficient, that is built to meet the need of our patients whilst protecting, growing and nurturing the GP workforce.

 

We submit in evidence, our collective perspective on the following questions:

 

 

 

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

 

We anticipate that the biggest challenge facing general practice in the next 5 years is down to the substantial increase in demand for primary care healthcare, with a large proportion of this falling to GPs to provide, as a result of demographic shifts towards a larger ageing population living with multiple and chronic medical conditions. Whislt patient demand has expanded in this way, general practice has not evolved sufficiently to adequately meet this need. We have instead witnessed growing rates of workload and work pressures within general practice which have unsurprisingly led to a rise in clinician burnout, a rise in early retirement, a decline in early career retention rates and a decline in full time equivalent contracts.

 

As GPs, we desire to provide care that is focused on our patient, that is safe, caring and holistic. This is proving harder to do in the current system which incentivises short and sharp consultations that frequently leave both clinician and patient feeling rushed. Reforms to general practice would need to reconsider the current doctor-patient consultation model to allow more flexibility in terms of duration, mode of delivery (eg. Face to face as well as virtual/telephone/ text etc) and multi-disciplinary team involvement. With the advent of Integrated Care Systems and existing Primary Care Networks models, we would like to see standardised guidance for multi-disciplinary practicioners within the GP setting, such as advanced nurse practitioners, pharmacists, physiotherapists, psychologists, social prescribers and more, to re-direct some of the workload away from General Practioners to other members of a diverse specialist primary care team. By standardising this approach and equipping GP surgeries everywhere to deliver this, we can better focus our efforts as GPs on providing specialist primary care where it is most needed: complex bio-psycho-social presentations. A move to GPs operating in this way could reduce the incidence of fragmented care that is currently observed in primary care and instead facilitate higher quality and  continuity of care delivered. We believe both patients and GPs would welcome this outcome.

 

Ultimately, we believe General Practice is currently at breaking point and without significant intervention by the government to expand the capacity within general practice and community primary care, patient need will increasingly go unmet and pressures will continue to grow and spread to other sections of the National Health Service, placing the whole health infrastructure at serious risk of failure.

 

 

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

 

Measures to address bureaucracy should include investment in more robust and centralised IT infrastructure which provides seamless communication, referral and data sharing between primary and secondary care elements of the health service. A robust IT system with clear referral pathways, clear data sharing platforms for results, discharge summaries, clinical communications etc between the GP and every other health clinician involved in the patient’s care across the country would dramatically reduce the current burden of bureaucracy shouldered by GPs. In addition, such a purpose built IT system, should also provide patient with an easy and accessible means of organising appointments with their practice, checking results, requesting repeat medications and routine communication with the practice.

 

Where GPs are expected to spend time conducting non-clinical work such as reading and writing letters, checking results etc this time should be built into protected sessional time to avoid this work spilling over into frequent unpaid overtime.

 

In order to boost morale and avoid burnout, GPs want to feel valued by patients and by the government. This means clear and consitent communication supported by NHS England and the Health Secretary towards a zero tolerance policy to abuse directed at any member of the general practice team. This also means showcasing and celebrating the contribution of GPs to the health and care of local populations. This means generating capacity within the system for GPs to spend more time seeing each patient in order to provide good quality care whilst cultivating patient trust. This requires fostering a collaborative and productive working relationship between the GP workforce and the government’s Health Secretary and wider policymakers towards a shared vision of a better future for general practice in the UK.

 

 

How can the current model of general practice be improved to make it more sustainable in the long term? Is the traditional partnership model in general practice sustainable given recruitment challenges, the prioritisation of integrated care and the shift towards salaried GP posts?

 

As GPs we recognise that the current system needs some re-modelling in order to build capacity to meet the growing primary care needs of the population. Nevertheless, the current partnership model provides GPs with a degree of autonomy to flex and adapt services more readily to the needs and characterstics of the populations they serve. This degree of self-management deepens the community ties and community-centredness of a GP surgery in the same way that an independent local business is often more valued and trusted by a local community than an equivalent service provided by multi-national corporation. This sense of independence fosters tangible authenticity that is beneficial for shared trust, respect and co-operation between GP staff and patients.

 

However, current GP specialty training programmes do not sufficiently prepare future GPs for the non-clinical skills required to be an effective GP partner, such as management, finance, population health and leadership skills. Instead of phasing out patnership models, we would like to see greater focus on providing GP trainees and early career GPs with the practical skills to be competent and confident GP partners of the future. We are concerned that a model away from partnerships would be viewed as reducing autonomy and flexibility for the GP workforce which would likely have a detrimental effect on workforce retention rates and morale.

 

 

 

Dr Julia Darko (Lead Individual)

On behalf of The King’s College Hospital GP Vocational Training Scheme 2021