Written evidence submitted by Liverpool Local Medical Committee (FGP0343)

 

I am writing on behalf of Liverpool Local Medical Committee which is a representative body for GPs in Liverpool.  There are approximately 500 GPs (independent contractors, salaried GPs, GP retainees and locums) working across 85 practices with either GMS or APMS contracts.  Despite the Government’s target set in 2015 to have 5,000 more GPs by 2020, by the time we arrived in 2020 an additional 6,700 GPs were required to meet the target.  Liverpool, like other areas, has been affected by this, and there has been difficulty in recruiting GPs.

 

 

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

be tackled?

 

One of the main problems relates to insufficient resources and insufficient GPs .

 

o To what extent does the Government and NHS England’s plan for

improving access for patients and supporting general practice address

these barriers?

 

Some aspects of improving access have been successful patients now have ability to email, telephone, have video consultations, text communications as well as face to face consultations.  The provision of additional IT equipment during the pandemic has helped.

 

o What are the impacts when patients are unable to access general

practice using their preferred method?

 

If patients cannot access general practice, they end up going elsewhere.  However, in some cases they need support using some of the alternative methods, taking into account health inequalities.

 

There is real concern that the pandemic has affected people’s health, especially when they have not been able to access services when they have needed to, almost certainly resulting in excess deaths.

 

o What role does having a named GP—and being able to see that GP—

play in providing patients with the continuity of care they need?

 

Patients with long term conditions prefer to have one GP for continuity of care.  There is evidence that continuity of care results in better outcomes.

 

What are the main challenges facing general practice in the next 5 years?

 

Encouraging those in training to enter general practice.  Part of that relates to providing appropriate training in general practice so that they understand the partnership model, and see the benefit of it.  Related to this, one needs to address burdens related to either buying-in to premises or taking on long leases without the easy option of re-assignment.  Resolving issues related to the relentless demand on general practice needs addressing – the open ended contract does not help. 

 

How does regional variation shape the challenges facing general practice in

different parts of England, including rural areas?

 

With regards to Liverpool, health inequalities across even a small area do result in challenges in different parts of the city. This means that resources need to be appropriately targeted where needed most.

 

What part should general practice play in the prevention agenda?

 

General practice does need to work more closely with public health, and this works reasonably well when practices are supporting each other in localities.  Public health can assist with planning services, and facilitate monitoring and screening at scaleGeneral practices are not there to tackle the social determinants of health, however they can work together and support each other in the preventative agenda. 

 

What can be done to reduce bureaucracy and burnout, and improve morale,

in general practice?

 

The current GP contract, with bean counting in QOF and the Impact and Investment Fund can be demoralising.  Inappropriate transfer of work from secondary to primary care, is also demoralising.  Surely we should be working in a system that puts the patient at the centre of care, rather than one that pushes patients from pillar to post.

 

How can the current model of general practice be improved to make it more

sustainable in the long term? In particular:

Is the traditional partnership model in general practice sustainable given

recruitment challenges, the prioritisation of integrated care and the shift

towards salaried GP posts?

 

The partnership model works, and the recent review undertaken by Dr Nigel Watson in 2019 needs to be reviewed, and its recommendations considered.  It is acknowledged that younger GPs are reluctant to enter partnerships, but that is related to some of the burdensome issues detailed in the review. 

 

Do the current contracting and payment systems in general practice

encourage proactive, personalised, coordinated and integrated care?

 

The GMS contract does work; there are problems though with the short-term APMS contract.  The payment systems however are unnecessarily complex and need reviewing.

 

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 have increased complexity of the health care system; the introduction of PCNs had definitely not reduced the administrative burden on GPs.  There is benefit of practices working together in neighbourhoods or groupings.  They can provide enhanced, cost effective care for the populations that they serve.  One of the problems behind Primary Care Networks is the bureaucracy that seems to underpin them. Practices should be free to collaborate with each other, but not be intertwined with each other such that the problems or difficulties in one practice impact on all of the others within the network.  The Additional Roles Reimbursement Scheme process has added to the complexity of providing integrated care, especially as this workforce is employed across practices.  

 

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?

GPs are used to working in Primary Care teams, with other professionals but it seems that successive initiatives have resulted in fragmentation of those teams such that patients are cared for in silos as opposed to holistically. 

 

Dec 2021