Written evidence submitted by The Drayton Surgery (FGP0260)

 

The Drayton Surgery is a 6-partner GP practice serving around 18,600 patients in the North of Portsmouth. We employ five salaried GPs and four Nurse Practitioners alongside practice nurses and Health Care Assistants. This team alongside our allied healthcare professionals, administration staff and management team provide good, safe and accessible primary care to our patient population. We are part of North Portsmouth PCN which consists of 3 practices, and we are currently the majority stakeholder within our PCN. We have a vested interest in the future of General Practice and feel it is important that GPs have a voice in any decisions made regarding the long-term future of Primary Care.

 

For our patients, we operate a triage first system; this was adopted due to the Covid-19 pandemic from a desire to keep our patients safe. Currently we operate this system for two reasons. Firstly, the pandemic is ongoing, and our patients could be exposed to Covid-19 if they were in a crowded waiting room. Secondly, we are experiencing a high level of patient contact. This system enables us to manage the demands on our appointments. Patients have multiple ways now to contact us as a practice, including telephone, email and e-consults. We would be unable to offer all these patients a direct face-to-face appointment, triaging them ensures that all our patients are dealt with in a timely and appropriate fashion.

 

Unfortunately, the reality of General Practice at the moment is that there are simply not enough GPs for the number of patients. Recent figures have shown a reduction in the number of FTE GPs. In Portsmouth we have one of the lowest rates in the countries of GP to patient ratios. An obvious way of improving access for patients is to increase the numbers of FTE GPs. Due to the reduction there is a knock on effect to accessibility for patients.

 

There has been much discussion in the media recently regarding “part time GPs”. The reduction in the number of sessions worked by GPs is multifactorial including: childcare responsibilities, increased workload, and the development of portfolio careers. In our practice we consider 9 clinical sessions as full time, and very few clinicians work to this number. However, many of our GPs hold other roles within the system including: working out of hours, PCN development, roles within the local GP Federation, safeguarding roles, and working within the Sexual Assault and Rape Crisis service. Due to the increasing workload and the intensity of the work at present it appears to be unsustainable to work full time as a GP, and would likely to lead to burnout very quickly.

 

To make General Practice sustainable long term and improve retention, workloads need to be sustainable. GPs need to feel satisfied with the care they deliver to their patients. This means enabling time for GPs to spend time delivering care to patients as they need, rather than feeling rushed due to the demands on the system.

 

Due to the lack of GPs, patients will need to learn that going forward they may not always see a doctor, but that there are other health professionals within the team that can provide the care they need. One of the drivers of patient dissatisfaction at the moment is the tension between being provided the care that they need, versus the care that they want. An honest conversation with the public about the limitations of the health services from central Government would help patients to understand why they cannot see a GP when they want to, rather they will see the clinician that they need to, when they need to.

 

We have fully embraced the allied health professionals that the PCN has provided. The pharmacy team in particular has reduced the administrative burden on the GPs within the practice; we have access to both pharmacists and pharmacy technicians via the PCN. In particular they conduct medicine reconciliations when patients are discharged from the hospital, and also undertake regular medication reviews with patients. These are tasks that previously would have been completed by GPs, so by providing these functions, more time is made available for GPs to focus on patient care.

 

Whilst this positive step has increased the time available for GPs to see patients, the reporting required for the PCN funding has increased the administrative burden for the clinical and managing directors of the PCN. Reducing the reporting needed would free up the time for the PCN staff to focus on patient care and ensure the resources were being focused where they were needed within the organisation.

 

The traditional partnership model is the heart of providing personalised care for patients. Partnerships ensure there are a group of clinicians invested in the future of the Practice. Due to the longevity of partnership tenure, they have a good understand of their local populations and their unique health needs. Whilst all clinicians who work in primary care work hard, partners provide a backstop within the system as they have ultimate responsibility for the care provided to the patients. Partners pick up unlimited additional work as and when needed. They can flex to the needs of the patients and are not limited to seeing a set number of cases or working a set number of hours in the way most salaried doctors are within their contracts. A move towards a salaried only model would remove this flexibility, resilience, and ownership. This would likely lead to a further reduced service to patients and be less cost effective. Instead of moving to a salaried model, the partnership model should be celebrated and supported going forward.

 

A further benefit of the partnership model is the ability to react at speed to changing environments and population needs. For example, during the Covid-19 pandemic we have changed our appointment system multiple times to allow us to respond to the changing situation. In-line with government guidance we very quickly reduced our face-to-face appointments. When it became apparent that this was not meeting our patient needs we were able to quickly increase this again. We have also increased our e-consult capacity due to the massively increased use of this facility over the past two years. If the partnership model were to be replaced with a salaried model the ability to respond quickly and adapt to our individual practice and patient needs would be much more difficult and far less reactive.

 

A quick way to improve morale across General Practice would be to show support for primary care across the system. We are aware that our hospital colleagues are not always supportive of the care provided to our patients and some have been very vocal in the media regarding the current state of primary care. Ensuring that all clinicians spend increased time within General Practice throughout their training to understand our role and the limitations of primary care would help ensure there was better feeling between primary and secondary care. Removing some administrative burden would help as this would allow clinicians to focus on patient care, which is why they came into healthcare in the first place. Ensuring that secondary care can follow up on their own results and do their own onward referrals would help.

 

Continuity of care is important to most patients. For certain groups of patients, it is known that seeing the same doctor improves outcomes and reduces emergency admissions. Whilst having a named doctor may help this, the current pressures on the system are such that we are struggling to deliver good continuity of care where patients are only seen by the same clinicians. For some patients this is not important and for them access is their priority. Unfortunately, in the current climate with reduced GP numbers and a growing aging population good continuity of care is hard to achieve.

 

We are a thriving practice who look to the future with optimism. However, the system is incredibly strained. There are not enough GPs currently and unless this situation is rectified the current access problem that some patients are experiencing is unlikely to improve. The answer to this is not to remove the partnership model, but to support practices and improve numbers of GPs. This should be in addition to ongoing support from allied health professionals as well as their integration and acceptance into primary care. This would lead to a less tired workforce, who felt more able to deal with the day to day stressors of life as a modern GP.

 

The Partners of The Drayton Surgery,

 

Dr N O’Rourke

Dr A Drake

Dr C Day

Dr V Cassidy

Dr M Swindells

Dr H Foakes

 

Dec 2021