Written evidence submitted by Anonymous (FGP0347)

 

I am a GP partner working in a medium-sized practice of 9000 patients. I have been a fully qualified GP for the past nine years, and a partner for the past eight. I welcome this call for evidence. My report takes the form of brief notes and points, as I am writing this during the middle of another busy week.

I don’t necessarily feel there is a problem with patients accessing general practice. Indeed, we are far easier to contact than any other service in healthcare. I was the on call GP yesterday, and by 2pm we had over sixty patients on the on call list – all of whom would speak to a senior GP that same day – even if they do not clinically need to. The vast majority of these problems could be dealt with by phone, with the option of booking patients into face to face appointments if they were needed. The list continued to grow throughout the afternoon (though at a slightly slower pace) and I finally finished my calls at 19:15, mentally exhausted.

I appreciate that I can only refer to the experience in my own surgery, but anecdotally we are not alone in these vast volumes of patient numbers. It is unsafe, in an NHS where we are (rightly) trying to improve patient safety.

Patients can very easily access general practice – in any number of ways:

-          Face to face appointments

-          Telephone appointment

-          Online consultations

-          Emails

-          Letters

-          Handwritten notes addressed to their GP of choice

-          Online messages

 

They just may not get the answer they want, the appointment they want or to see the person they want.

In terms of the main challenges facing general practice in the next five years:

-          GP numbers falling further.

-          Demand that is increasing exponentially – and which we are unable to say “no” to. Contractually we are unable to cap our on call list which puts patient safety at risk.

-          Huge backlog in secondary  care – meaning that I am having to manage all the patient who are waiting to see a specialist. This was a problem before the pandemic, and is getting worse and worse. Most patients now won’t be seen by a specialist for around 6 months – again, this is a patient safety issue.

-          Supervising more non-GP’s which takes us out of being able to consult with patients.

-          Anti-GP rhetoric by this Government and the media.

-          Sheer lack of mental health services – for both complex patients, but also more mild stress/ depression/ anxiety.

Regarding the prevention agenda:

-          I’d love for us to do more of this – but we don’t have the time.

-          There needs to be a massive push for health promotion – investing in this now saves money in the future and would help to reduce workload not just on GP’s, but the rest of the health service too.

What can be done to reduce bureaucracy and burnout, and improve morale, in general practice?

-          Stop telling everyone how rubbish we are!

-          It should be an enjoyable and rewarding job – being able to help the general population lead a long and healthy life, and support them in times of illness or stress. It’s not, because I am trying to manage too many people, without adequate support from specialist services.

-          Shared computer system – if everyone used the same system then I wouldn’t need to keep filling forms in or writing lengthy referral letters. A simple – “please see my notes” would suffice

-          Gaps in commissioned services. For example, we see a large number of patients who have mental health problems related to their physical health problems, which are often related to significant psychological trauma or harm at an early age. There is no support available locally for these patients – they may get 6 sessions of counselling which is inadequate.

Re GP partnerships:

-          I feel this model is still very effective – if you can get a partner. I love the partnership aspect of my job – it provides a different type of challenge and can be satisfying and rewarding. It also means I have a long-term commitment to my practice and my patients resulting in continuity of care, ownership and responsibility. I am motivated to want to keep improving the service we can provide and to help shape the future of our practice. I don’t think you get this with salaried GP’s.

Re PCNs:

-          Our practice is part of a successful PCN – we worked together on certain activities before PCNs existed. I believe they have a role – eg coordinating the vaccine roll-out locally which was incredibly successful. I don’t believe they have resulted in improved delivery of proactive, coordinated and integrated care, and it has certainly not reduced the admin burden on GP’s – it has merely changed this.

-          Part of this is due to having to supervise other team members/ PCN staff to do work that I was previously doing. Given the lack of GP numbers, as a senior GP we are having to supervise more and more junior GP’s, medical students and other clinical staff (such as PCN staff).

-          Our PCN staff do a great job. There is still a significant proportion of patients who don’t want to see allied health professionals. For example we have patients who will still insist on seeing a GP for their musculoskeletal problem, despite having a first contact physio in the building.

 

I believe we are absolutely vital to the health of our nature, and to keep the NHS going. I’m not sure how much more of this I can take though.

Dec 2021