Written evidence submitted by Salford and Trafford LMC (FGP0317)

Salford & Trafford LMC operates across both Salford and Trafford representing in total, around 75 Practices and 330 GPs, covering a total population of 500,000 residents. We exist solely to represent, advise and support GPs and their Practices.

One of the main challenges to accessing general practice is due to the misalignment between policy change and implementation, digital capability, patient and professional behaviour and  expectation, and less about the GP model itself.

Prior to CV19 the Health Secretary placed great emphasis on General Practice embracing digital technologies. Practices were piloting new digital platforms and they and their patients were adapting to a new world together. CV19 arrived and the piloting transformed overnight into full implementation. Practices and their staff adapted how they delivered care, prioritising keeping their patient and workforce safe  at an unprecedented rate, and patients embraced the change as the alternative was not an option. Practices overcame the issue of inadequate digital infrastructure they had no option other than to work with, and continually flexed their access in accordance with patient need. Those who were not digitally savvy were offered solutions which ensured equity of access.

During the time where many other sectors such as Community, Acute and Mental health services stood down services and redeployed staff, General practice delivered more appointments than in any other year. They took and continue to shoulder the burden where other patient facing services are yet to be fully stood back up, and work tirelessly to reduce any negative impact on the health of their patients, often to the detriment of their own.

Our LMC has recently published an inappropriate workload shift review from other Sectors to General Practice. It highlights not only services which remain paused such as community rehab, but the multitude of tasks which Providers are contractually required to deliver under the NHS Standard contract themselves but are instead passed to General practice for them to undertake in addition to their own contractual requirements, whilst others ‘build back better’.

The survey can be found here: www.salfordandtraffordlmc.org.uk/news/14-12-2021/inappropriate-workload-shift-review/

This inquiry comes at a time when there is a high level of  attack on the profession – you have to do face to face, you have to declare your earnings, you have to not react whilst your patients abuse you https://twitter.com/LMCSalTraf/status/1448939256131489814?s=20)

you have to open up your booking system to NHS111. Whether intentional or not, it seems Government view General practice as the root cause, rather than addressing the much wider system failings which have led to a sector being completely overwhelmed by demand, not through their lack of action, but through the actions and inaction of others. The issue is exacerbated as some believe the sector is there to serve irrespective of whether a request is clinically appropriate or reasonable. Perhaps if the focus of the inquiry was centred on how we can all ensure services are used appropriately, addresses patient misconception, and empowers society to take responsibility for their own health and wellbeing in partnership with their GP, General practice would not only survive, but thrive with a profession who have trained long and hard to be skilled to deliver proactive and planned care to millions, across all ages, at the core.

The GP partnership model has a multitude of advantages to both the NHS system and patients and their communities. It provides continuity and place-based care, which

has the ability to adapt as demonstrated over the years with the changes to contracts, performance targets and more recently to focus on population health management and prevention as demonstrated by the response to the establishment of Primary Care networks and the pandemic. The model provides holistic care to the whole of the registered population of a general practice, centred around a lifelong medical record and knowing more than one generation of a family. The freedom to innovate, being a central part of a community and being accountable to that community are all enviable strengths. Partners in Practices are clinically and financially liable for all that their Practice is contracted to deliver and beyond, which promotes ownership, sustainability, and loyalty, embodying selfless dedication and sacrifice. 

There is no doubt that the current contractual model requires careful consideration and refreshing but this does not mean that the partnership model is of itself flawed and unsustainable, in fact it’s quite the opposite. Abolishing the Partnership model and all it brings, switching to a salaried model or Trust led Primary Care service presents significant risk to the NHS, as the manner in which they operate hugely differs. It is difficult to see how  moving away from a model which provides stability and continuity entrenched with patient/GP trust could be considered a more viable and preferred option? Perhaps it’s because the people believing the model is flawed, do not understand or recognise the value it brings?

The ICS focus whilst based on efficiency and removing bureaucracy is embracing placed based, community led care, and is moving away from the one size fits all. The foundations of evolving Primary Care Networks are set on GP practices led by family doctors who understand their populations and have long-standing deep-seated relationships with their patients.

Whilst the investment the PCN DES is welcomed, the inflexibility and limitations within the spec are prohibitive. An example of this is the Mental health workers having to be a shared post with the Mental health providers. There is insufficient workforce within some areas, so rather than adding capacity, Practices are deprived of sourcing additional capacity from elsewhere who can meet demand.

If the NHSE and the Government are serious about improving the health and wellbeing of the population, they would be preserving the current  GP partnership model and ensuring the services which run parallel or in competition, support and nurture  partnership working to enable out of hospital provision to flourish for the benefit of their patients, rather than focus efforts to undermine the sector which holds the key to unlocking the potential of truly integrated working.

Dec 2021