Written evidence submitted by Boultham Park Medical Practice Patient Participation Group (FGP0258)

  1. What are the main barriers to accessing General Practice and how can these be tackled?

There is a limited number of online appointments available for future booking. Consequently, patients are reliant to the “ring on the day” process. This is extremely limiting to those who need to attend work or those with parental duties.

Increasing numbers of people due to new housing estates in the area creating increase in volume of work without increase in GP resources.

Reluctance in many people to take responsibility for their own health. Although there are weight management programmes available and support from health staff, people are not always willing to take advantage of these. Although weight problems can be complex and difficult, it is so important for Health Education to be available and should be provided as a national resource and should not only fall onto GPs to provide it.

As part of a national Health Education, a programme highlighting the range of medical professionals within a GP Practice who are able to see and treat patients should be highlighted. This will therefore free up GP time. This will target patient mind set over time and improve as patients become more used to using other Health professionals rather than GPs.

Use of technology and online services (eg: repeat prescriptions) is one way to improve access for patients. While this is good for some people, it continues to exclude those who are not able to use technology. Particularly where appointments are carried out on line. Our PPG has provided support and learning opportunities for people but there is more to do which cannot be carried out with the current COVID restrictions.

 

With a limit on being able to book advance appointments on-line puts additional pressures on the over worked receptionists and the telephone system.

Patients may not be able to attend an appointment at short notice on that day, or may have to take time off work therefore loss of earnings.

Patients may leave issues therefore they could escalate to missing early signs of treatable illnesses. It could also lead to an increase in use on emergency out of hours services.

 

Continuity of care should not be dependent on seeing the same GP. Patients should have trust in their surgery so that whoever they see, they are comfortable that their history has been reviewed and that they will always receive the best level of care and customer service.

Patients presume to see their GP and to continue this, it creates a stigma that only “your Doctor” could provide you with the appropriate treatment. This naturally then has a knock on effect to other areas of medical services, such as if you are referred for longer term treatment. Patients should be confident in the service, not just in an individual.

For patients with a long term chronic condition there are advantages to having a named GP or a named nurse with special expertise eg: asthma. It would provide good continuity of care from both the patient and professionals point of view. For one off consultations to be seen by an appropriate person should be fine as long as they have access to the person’s notes

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

Modernising the communication methods and getting patients to engage with them. Telephone consultations have been introduced and while this works fine for some people and some conditions, they are not the answer for all situations. Although telephone appointments may be deemed to save time they still take some time up for the doctors too.

Staffing. In the past people may have been able to “pop in “and make an appointment but now we all need to telephone and this can take a few calls to get through to the surgery and causes annoyance and lack of understanding. This leads to rude and unnecessary behaviour towards reception staff. This is totally unacceptable and in reality upsetting to all.

The main challenges for the future will be a result of increased populations, increased people with complex health problems and long term conditions, loss of health professional staff due to retirement/or wish to move to other areas, secondary care expecting primary care to take on extra work to relieve their services

 

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

Rural counties, such as Lincolnshire, struggle to recruit and with poor transport from the larger cities, commuting is often not an option. There is a huge challenge in Lincolnshire with such a large rural community which does not attract the same number of applications for jobs as it would in our cities. They need to be resourced very differently to make them attractive

Increase number of patients as townships expand within Lincolnshire.

New bigger medical practices coming to areas but at the loss of several small village surgeries being closed. This probably means same number of Doctors and staff but loss of local buildings. This will impact on local residents and cause transport issues.

 

  1. What part should general practice play in the prevention agenda?

If staffing was better, GP surgeries could focus on promoting proactive wellbeing initiatives rather than reactive treatments. Many conditions are partly avoidable (obesity, asthma through smoking, Type 2 Diabetes, liver disease through alcohol), however if GP surgeries were given the resource to support preventative measures they could be key in the agenda.

General Practices should be connected to local schools to help with the education agenda regarding health.

 

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

General Practices are rarely publicly praised for their support in communities and their services, other than standard appointments, are often not known. Positive promotion of their full services and recognition of the impact they have to keep the local community “well” would boost morale.

Morale may be improved on a daily basis if other services worked together with respect for each other and admin systems are better streamlined.

Announce to Practices first any changes in National policy  rather than Practices finding out about changes via media that means patients are confused as to what is available and when. Recent changes to COVID vaccine rules led to inordinate numbers of telephone calls to GP Practices by confused patients. The media could do so much more to help with healthy eating, regular exercise, and reduce the expectations of the GP. Self help should always be encouraged.

 

The media could also try to quell the members of society who take great delight in abusing medical workers.  The very good work that the GP's carry out every day is rarely given credit

NHS England need to do more to retain GPs who are choosing to leave the profession and new GP's are hard to find. This profession should not be under such strain

The NHS has just told GP's that they can defer certain elements of their work but that only makes their workload grow as the jobs are still waiting and some of those patients will have lost out on an early diagnosis- now even more work for the GP.

 

Every person in the UK needs a good GP practice to be available at their time of need. Clearly this is proving to be impossible to deliver and unless this issue is dealt with urgently on so many fronts we will lose one of our greatest assets. The GP practice has been the centre of so many communities and without it the standard of our health will decline

 

  1. How can the current model of general practice be improved to make it more sustainable in the long term? In particular:

Currently General Practices are struggling to manage the increasing demand for appointments while it is so difficult to recruit doctors as General Practitioners; necessary time and funding is taken up negotiating complicated GP contracts, this system needs to be simplified, while university places for GP trainees need to be opened up with a targeted recruitment programme in place.

 

Introduce the Integrated Care System so that there is a more streamlined system for the users? In theory this should benefit the GP's, other NHS staff, Social works and patients

The Government is not listening to the staff and asking for example, this submission is to be returned with a very short deadline. Our PPG have just 12 days to plan and submit which is extremely short notice to give volunteers who have other commitments.

The rate of effort put on GP Practices by NHS England/Central Government has increased so much it is now become unsustainable. Doctors are regularly working 14-hour days and still having to deal with the emails of the day in the evening. They are subject to abusive and threatening calls and emails from patients on an almost daily basis, causing additional stress and it is not unusual for them to leave staff in tears, and, in some cases, to leave the Practice. Consequently, in what was once a happy, vibrant Practice, staff morale is at an all-time low

 

Dec 2021