Written evidence submitted by Bilbrook Medical Centre (FGP0252)

Evidence from Bilbrook Medical Centre, Staffordshire

We are an 8000 patient practice in semi rural Staffordshire, partnership model practice with salaried doctors and a wider practice team which involves PCN additional roles such as social prescribing. We are a training practice and rated outstanding by CQC.

We have encouraged a practice wide conversation to respond to this request for evidence. We felt as a practice a responsibility to provide an accurate reflection of the challenges faced by general practice from our perspective and in doing so to be involved in the process of trying to find solutions to a complex problem.

Workload GPs/nursing team and admin staff – this is increasing exponentially.

Many reasons for increasing workload over time. We have seen the complexity of the patients we are seeing and expectations around care increase. We are increasingly taking on patient care which would traditionally have been managed in secondary care but without the resources or workforce to manage this to a standard we would like. More complicated patient care managing patients with multiple comorbidities and long term conditions impacts on doctor and nursing staff workload.

Additional roles whilst welcome do not necessarily translate to reduced workload – they frequently involve time such as helping train roles and tasks associated with the roles feeding back to admin staff and clinicians. The success of these additional roles has also appeared to be dependent on quality of the individuals employed. Unsatisfied patients will simply rebook appointment with a GP. We have had some positive experience of additional roles however and have an excellent social prescriber working with our practice.

Extended access roles and locums in a similar way involve more tasks once a clinician has seen the patient – tasks are then sent back to the patient’s practice and may not always be appropriate as the clinician does not have established knowledge of the patient. Employing locums , for example as part of winter funding, does not always translate to the type or standard of care that patients expect and can result in large volumes of tests ordered and frequent repeat consulting.

Recruitment of quality clinicians and administrative staff very challenging so trying to provide quality care with a reduced workforce. Majority of clinicians now part time, this needs to be supported and acknowledged within workforce planning.

During covid pandemic a reduction in external and community services has meant primary care is picking up these patient needs instead.

Long waiting lists in secondary care have increased our workload too, as time is spent consulting these patients whilst they await opinion/treatment, supporting them and writing letters to try and expedite appointments.

Some services have very narrow criteria for referral meaning few patients are able to be referred such as podiatry.

 

Interface between primary and secondary care. Difficulty for primary care clinicians to communicate with secondary care in a timely manner, different IT systems, variable quality of discharge/clinic letters. Much time is spent with GPs being the “middle man” trying to enable communication between secondary care specialists and the patient. The specialist-led system in secondary care leads often to a not very holistic outcome for patients. They often end up being referred to specialities who may discharge them but rather than refer on to appropriate hospital colleagues to continue care or plan next step, letters are written back to the GP to ask us to re refer patients instead. Overall a lack of joined up care exists. We don’t feel this is in patients’ best interests.

Increasing workload and demand for the practice team can lead to reduced morale and stress/burnout. This in turn will inevitably have a negative effect on patient care and satisfaction as well as increasing the problem of recruitment and risk of medical errors.

We believe that we have an important role to play in promoting patient health and wellbeing rather than just addressing the health needs as they arise. Time pressures make this difficult to achieve despite our hope and desire to do so.

Complex referral pathways that are ever changing and cause confusion. Many of the pathways insist on GP completion despite GPs probably not best placed to provide this information. The referral forms are increasingly lengthy and complex to complete.

IT system under strain. We have had an IT system with some significant problems for a number of years but unfortunately despite our best efforts to follow the appropriate channels to resolve them , these continue and can hamper progress, taking precious time and at its worst have the potential to cause significant events.

Continuity of care has been shown to benefit patients and provide better quality of care, likely to reduce patient contacts too but is difficult to achieve whilst also allowing good patient access. We have shown the benefits in our Care Home enhanced service but it is not possible to extend this practice wide for all.

The role of our administrative team has in addition become more complex. A single patient contact can involve a lengthy process to sort out within little time given the multiple contacts in a day to manage. This leads to reduced morale and staff stress.

In summary, as a busy training practice, trying to navigate an increasingly complex and ever expanding workload is proving challenging. We are a positive practice with a strong work ethic and are proud of our achievements putting patient care at the centre of what we do but can see how the current situation is impacting staff both in administrative and clinical roles and how it influences ability to recruit an already understaffed primary care system.

Dec 2021