Written evidence submitted by Philip Heiden. Managing Partner at St Paul’s Surgery Winchester & Adelaide Medical Centre Andover (FGP0339)

What are the main barriers to accessing general practice and how can these be tackled?

The sheer volume of contacts from patients means they can be fighting to have their voice heard. Contacts have increased 30-40% compared to pre-covid levels despite several other services trying to take work away from General Practice (first contact MSK, minor eye conditions service, for example)

The level of anxiety in the general population is extremely high and trying to differentiate between pathology and psychosomatic factors can be very difficult. Mental health has deteriorated significantly and the services available for these patients are inadequate.

The narrative from the Government is that you are entitled to see your GP face to face and this goes against what was directed at the beginning of the pandemic and the previous health secretary (Matt Hancock). What is clear is that GPs are unable to manage the level of demand with the previous model and a mixed model is currently the only way of coping. The Government’s narrative has been directly driving demand and abuse from patients, and further hindering the recovery in General Practice.

The recent Winter Access Fund is an example of the Government being completely out of touch with the realities facing General Practice and offers no real solution to the issue.

These plans contribute to the problem as they require a great deal of communication and discussion, further taking away GP access. We end up debating how we can use this fund in an impossible situation which is time consuming for something which is only going to last a few months.

The strict target based approach to PCNs also hinders innovation and improvement in patient care and access as ARRS roles are focusing on these rather than any tangible benefit or workload reduction.

 

Less of their preferred method but more so within a timeframe that meets their impatient needs when not classified as a clinical priority.

Increased contacts to hospital, OOH and ED. Frustration leading to abuse.

We run a strict list based system at St Pauls & Adelaide and it works really well. We can have up to 50 contacts a day from patients but in the context of knowing them and the family, decisions are much easier and quicker. This is the only way of managing the high level of demand.

Patients build a rapour with a clinician and therefore more at ease to open up and trust decisions. Consistent healthcare approach/plans reduce patients confusion.

Continuity of care at family level is great to piece together puzzles and helps with safeguarding

 

 

 

 

 

General practice struggles to firefight at the moment. It isn’t going to have the capacity to be majorly involved in a prevention agenda although it’s very important. Clinicians can discuss, influence, refer to lifestyle changes services but without the workforce/funding can’t run these services

We need a supportive government who are listening to the challenges facing us. A shared vision with realistic expectations set and conveyed to our patients. Greater focus on self-care. A period of standstill rather than huge sweeping changes (CCGS, ICPS, MCPS, PACS, PCNS, Federations) & (do this service for 4 months now do this service for 3 months). Longevity to services/ contracts.

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

Increased workforce.

Medical students to have a greater focus/ placement within general practice. Selling the positive career option.

A period of standstill rather than huge sweeping changes (CCGS, ICPS, MCPS, PACS, PCNS, Federations) & (do this service for 4 months now do this service for 3 months). Longevity to services/ contracts.

The partnership model is in my mind is what makes the NHS. Yes it would be sustainable if it was backed and respected by the government and invested in.

You will not receive the same goodwill, capacity, innovation, efficiency or healthy competition patient choice if you replace the model with a salaried one, an MCP or PAC.

If you force the shift to salaried you will lose a large amount of workforce overnight and staff that will work to rule on hours if on agenda for change (AfC).

I personally took over a failing practice and with 15 months turned it around from a bottom of the leader board to the a near top of the leader aboard across every metric. The practice remains as a Partnership today. I challenge you to compare (case study) our recent take over vs a private, community or secondary care provider take over which have been happening locally or nationally and reasons why the Partnership model helped this.

 

No, they are target based and the same throughout the country

No, it has considerable increased the administrative burden on GPs/ Managers. There have been some benefits to the ARRS roles but they require supervision and training and this seems to be a net input at the moment. The roles are then not delivering personalised care as they are working towards the proscriptive NHSE targets. PCNs are still fairly new and throwing practices together takes time. Storming, norming, forming.

First Contact physiotherapy has been a good example of workload being taken away.

Minor eye condition service and seeing optician first has also been helpful.

I would like to see eConsult take more risks and signpost directly.

 

Dec 2021