Written evidence submitted by Giffords Surgery (FGP0318)

 

 

-          Access issues are perceived to be an issue locally due to the national media campaign around this but in reality, access is very good. Patients all speak to a clinician on the day and are seen if they wish or if there is a clinical need. I feel increasing modes of access risks patient safety and creates so much volume of patient queries it gets harder to see what is important and what is not. Based on this I feel compulsory online access/e consults is not wise.

-          The media’s portrayal of GPs is incredibly damaging and does not reflect what is happening in practice. We have increased GP and clinician levels, see more patients than pre pandemic as well as delivering as a PCN 70, 000 CV vaccines in the last 11m.

-          Less GP bashing would help the public understand what we can do and what we can’t. They seem to be unaware secondary care waits are not our fault.

-          Too much choice actually makes it confusing to patients – patients don’t know who is best to access and how. Having several ways of contacting GP’s may mean they attempt multiple ways at the same time, clogging the system & duplicating work. i.e. if can’t access by phone they will walk to surgery & send in e-consult. 3 points of duplicated work. Patients need a single contact point at surgery & in the community with good navigating to appropriate services.

-          I don’t perceive there are barriers to patients accessing GP. Practices offer appointments via phone and for those with difficulties using phone there are policies in place to manage this cohort – email/arranging F2F. The issue is with the GP workload, which does not always allow patients to engage with a GP at a time of the patients’ pleasing.

 

-          Creating rules around the number of face-to-face contacts is crude and makes no sense and demonstrates an utter lack of understanding of how we work and how our clinics are structured.

-          I am not sure giving pts full automatic access to records on the NHS app is of value. Already pts having full clinical online access creates huge volume of consultations where patients want things explained of have interpreted something incorrectly. At least currently patient s requests their access ie self-select

-          They don’t – as per point above – giving more ways to access GP’s/services just leads to increased confusion from patients about who to call & how to access.

-          E-consultations are encouraging patients to seek advice “quickly” about more minor ailments that don’t need clinical advice, thereby taking up precious time, GP’s – under fear of increasing litigation – still have to process these to a higher degree. It also continues to eradicate the need for patients to take responsibility for themselves and their actions

 

-          I do not feel patients immediately head off to A&E or 111if they can’t get through to the GP surgery. Patients

-          I think the majority of patients will use online information to look up advice, they may call 111 for advice or seek advice from family/friends. I think patients only turn up to A&E when genuinely worried as the usual long waits will likely dissuade those with more minor complaints that they are less concerned about. Patients will try contacting GP on another day

 

-          This is irrelevant these days. The governments drive for health professionals ( non GP) means lists are outdated. We aim for continuity at the point of patient contact and episodes of care are completed by the same clinician. Patients migrate to the GP they prefer which is fine. Having a names GP ie lists means the GPs carry enormous lists as ANPs etc cannot. This means admin/results/FU does not go to the person managing that episode of care.

-          A named GP is generally irrelevant for the patient. This is really only exists for political & administrative reasons. The way society has changed does not allow for this (longer working days/weeks, female GP’s, bigger emphasis on quality of life). Some patients will either seek a particular GP and remain with them for that episode of care. The majority – mostly when considering acute presentations -generally do not have a preference about which clinician they see.

-          Continuity is important for long term conditions. GP’s would prefer it. Patients will generally self-select the clinician they wish to see. Many practices can try using buddy’s to aid continuity but it is unrealistic that GP’s can work every day at their current workload.

 

 

-          The belief that secondary care is the most important needs to change. We are seeing more and more secondary care work come to us especially as they move to more OPCs by phone.

-          When hospitals are under pressure, we get e mails telling us and advising don’t refer in unless unavoidable. Never does primary care get the opportunity to feed back in similar terms to secondary care when we are drowning in patient demand/hospital work.

-          Flexibility to recruit who we need not who we are told to recruit. That way the recruitment pool is not instantly drained, and we can get staff who will benefit our individual service provision and community needs.

-          Staffing. Low morale is driving skilled clinicians away from GP (& medicine). Even newly qualified trainees are leaving and most are not being trained to cope with the relentless workload that exists, so quickly become disillusioned and quit medicine.

-          Workload. GP’s cannot continue to be the fallback system for the NHS. We need to have clearly defined roles and responsibilities with appropriate renumeration for the tasks we perform.

-          Managing patient expectations of what the NHS can/can’t provide. How can we help get patients with chronic pain/depression etc off meds, getting better and working – trying to follow NICE guidance - when we have no support services or infrastructure locally in our communities – counselling, pain clinics, exercise classes etc to offer them?

-          Litigation – increasing complaints and litigation causes a culture of fear in clinician. Causing increasing consultation time due to documentation.

-          Uncertainty – uncertainty about what is happening in the NHS and GP

 

 

 

 

-              Believe that it is GP partners that are propping up primary care- loose these and the whole system will collapse.  I regularly work 12 hr days and catch up on management work on days off, evenings and weekends. If the patient demand is high partners protect their staff (in case they leave) and do more. So look after partners and be aware if their earnings are higher than 150K it is because in addition to their FT clinical role they have been running vaccine programmes, doing extra sessions to cover staff gaps and protecting their staff from feeling too much pressure from the huge patient demand.

- Stop wasting money on top end “re-distribution” (Comissioning groups -> PCT’s -> CCG -> ICS ) They all serve the same role and so much money is wasted in the re-design and “talking” by management. Also wasting money on ill-thought through projects i.e. data/NHSapp

- Clear delineation of primary and secondary care duties. Payment by work done. Ability to have a clear route to push back work to secondary care without GP’s being seen as the “bad guys” by patients/media/secondary care.

- Enable other professions/secondary care to make referrals. Waste of our time reading outpatient letter requesting a referral then us having to complete another form for a referral about something we are not directly involved in. Just adding another time-wasting step.

- Let GP’s feel they are not the dumping ground for anything. Improved social care

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  1. Is the traditional partnership model in general practice sustainable given recruitment challenges, the prioritisation of integrated care and the shift towards salaried GP posts?

-          I don’t think there would be a shift to salaried posts if partnership was made more attractive in terms of workload. I think the partnership model works and gives patients and the NHS a huge amount of service and commitment for what they are paid.

-          Partnership model needs to persist otherwise the government will struggle to maintain the standard of service provision that patients have and currently receive. Salaried models will lead to clinicians “working to rule”, putting in no extra, and having no motivation to drive improvements for their own practice population. The government will need to pay so much extra to get the same level of patient care & satisfaction.

-          Allow partners to actually act as the independent business contractors they are – at times now, we feel there is little autonomy to do what you would like to do for your patients

-          Help make partnership more secure – particularly from the property point of view – which is probably one of the limiting & scarier factors for would-be new partners.

 

2         Do the current contracting and payment systems in general practice encourage proactive, personalised, coordinated and integrated care?

– we are increasingly restricted in our ability to create personalised care.

-          - No QOF does not always allow us to have personalised care as you are always trying to push patients to a better target, which might not be the best for the individual patient or to the patients choice. Practices are concern if they exception report too many as a result.

-          I feel the current contract & payment system is not always clear hence GP clearing up workload from other community services and secondary care with no recompense.

 

  1. Has the development of Primary Care Networks improved the delivery of proactive, personalised, coordinated and integrated care and reduced the administrative burden on GPs?

-          PCNs in my mind have just increased red tape, limited practices to being able to recruit certain clinicians and caused us to spend a huge about of time trying to work together when ethos and patient populations vary so much.

-          No, this has not enabled individual practices to do the best for their patients. Much time/effort/money has been wasted in trying to get multiple practices (with different populations/priorities/ethos/difficulties) working together, when in actual fact many practices have in the past chosen to work together on particular mutual projects that benefit their patients. Partners, as independent contractors and business owners – know their population and it would be better for them to have funds directly to use to benefit their own patients. Many practices would come together to collaborate on particular projects, but being forced to come together and forced to have particular services has created more disagreements and wasted more time & money.

 

  1. To what extent has general practice been able to work in effective partnerships with other professions within primary care and beyond to free more GP time for patient care?

– Haven’t seen much of this. Ultimately even if there are partnerships they all need mentoring, monitoring and the buck still stops with the GP- not much time saved.

-          Use of paramedics, pharmacists and physios etc to the GP team are helpful, but as stated above – the practices need to decide for themselves what services would be best for their patient population and staffing workload than being dictated to by management. There is the concern that this just pulls staff away from secondary care, so is not helping staffing issues in the NHS overall.

Dec 2021