Written evidence submitted by Anonymous (FGP0272)

The main barriers to accessing GP is capacity and demand. Demand for services is never measured at source but far out strips all capacity to manage patients safely. The additional requirement to manage both urgent same and long-term conditions under the same umbrella means that planned care is often superseded by same day care.

Patients often view their problems as urgent or same day when they are not. If patients used primary care wisely and routine and urgent care was separated access would be easier. The public needs to be better educated in self-help for minor problems and to understand how general practice is changing.

Routine care could be managed differently in hubs e.g. LTC review etc.

Offering a blended choice of F2F and telephone appointments, suits all patients working or not, we have consistently offered choice along side list of conditions that need to be F2F e.g. gynae,. abdo.

The plan does not account for the staffing crisis in primary care and the stretch to even cover a routine day’s work, and the personal choice for many who do not wish to work unsociable hours. The need for improving access is reduced by offering a choice of telephone and F2F.

Patients must use alternative methods; online contacts have increased by over 60% without the personal to manage them. Patient care is deferred, or patients must call 111, their conditions can worsen. Mostly if patients can’t use their preferred method, they bypass the queue and come down to the surgery.

Each government announcement generates more work and reduces access as the questions relating to COVID, jabs, exemptions, etc goes on and on.

Named GPs are important when dealing with complex patients.

Increased demand / staff turnover.

Complete lack of skilled staff and a competitive market – pay and conditions in GP must be improved. GP’ contracts could be improved by offering something like a hospital consultant, better time for proper admin, who works a full week but isn’t expected to do a full week of clinical sessions. Nurses wages undermined by ARRS roles being paid at A4C rates. Lack of ARRS roles, FCP, mental health.

Admin teams are integral and skilled– they deal with over 50 different tasks a day. High turnover due to abuse from patients and low pay.

Premises, and space to expand.

Acute trusts continually throwing work at Primary Care.

Access to services is difficult in rural areas, lack of infrastructure, especially when stripping away community care / hospital to bigger centres.

Is key in prevention and can lead in this area if given time.

NHS systems that generate more work that they take away, choose and book (not fit for purpose), NWRS, EDEC, PCSE payments, OE, etc all examples of software that generates work and doesn’t save time. IT needs to be upgraded but give practice teams proper training – we are often asked to use systems by just watching a video – we are not IT experts. We often do very repetitive tasks with no value.

Ask the teams what helps them and support them to be part of the design of new systems. PCSE payments simply rolled out over night with no engagement.

Fix the pension problem and how you can raise and resolve a complaint.

Give clinical staff a better timetable that allows for both clinical time and admin time to do their work properly and ensure that they have time to care but also time to carry out all other duties, workflow, referrals, advice and guidance, training, letters, reports etc.

Give Primary Care time in their diaries to develop and train teams, we are expected to be always open but with small numbers of staff you cannot effectively do this without realising time.

Properly fund Primary Care administration and workflow to ensure sustainability.

Please change the model of first come first served at 8am.

Separate Urgent / Same Day and routine / long term conditions / meds reviews into different hubs.

Too much change in the last couple of years forced through quickly, slow down and allow teams to adapt and grow, reduce expectations that we can do everything.

Government should see the value in primary care teams and support them in the media. Engage with primary care better and as equals in the ICS’s, practice managers are seldom asked or consulted in the development of local services, as a former commissioner I find this very frustrating.

Secondary Care teams should be accountable for changes they make to services and primary care should be involved in approving plans to support each other before any shift in workload is made. The funding should follow and changes. E.g., advice and guidance funded in secondary care but GP time to do A&G in PC not funded and as usual rolled out over night with a webinar.

Don’t roll out access to patient records, electronically this is such a big ask and the training required is expected to be done by the practice themselves. Access to patients’ records should be the reasonability of both secondary care and primary care. Who will support PC when things go wrong as we are data controllers for all information once we accept it. The time that this will take to check each record even for future entries is immense. Please consider talking to us further before this becomes a reality.

 

The biggest amount of work is recording, claiming and proving we have done everything again in multiple systems not fit for purpose e.g. CQRS, locally commissioned work books by CCGs.

No because during the pandemic we have had little time to fully engage and have generated more work than they have saved. It has added more pressure to our workload. Practice Managers shouldering the burden to make PCN work well, undertake the finances, recruit, meet targets, manage more staff etc. Over the last year BAU expected even when rolling out a vaccination programme.

New professions have helped but seldom see the same volume of patients as GP’s are expected to do. Overall demand is so great no time has been freed up for patient care. Patients still expect that GP is the only person who can answer their questions.

Dec 2021