Written evidence submitted by Dr Rowan Jones (FGP0358)


I am a General practitioner of 13 years experience (7 as a partner). I have worked serving semi-rural and suburban populations. I am currently a partner at Dorchester Road Surgery in Weymouth. I have sat of the bord of the local federation and have a role in training and supervising some locality employed services. The main challenge in my opinion facing patients in terms of access and also the workforce morale is of demand outstripping capacity. There are many factors contributing to this and I’m sure you will have submissions that break this down in both more academic and eloquent ways, but there is a very clear failure of workforce planning at play.

In the medium to longer term there clearly need to be strategies to drive career paths into primary care from nursing, pharmacy, physiotherapy and so on. These strategies need to be starting with numbers of undergraduates entering training and carrying all the way through. The current components of the PCN DES to aid recruitment of additional roles are too rigid and attempting to recruit from too small a pool of staff. There are barriers to moving staff from community and secondary care including training and the differences between agenda for change contracts and contracts in primary care.  Many doctors within general practice are disengaged and disillusioned with PCN structures and see little of the benefits they should bring helping their day to day life. If anything it has added to administrative burdens, taking doctors and management staff away from patient facing work. All the significant developments in proactive more individualised care at a locality level had been made in my area before the PCN DES. At least part of current problems are that many of the PCN employed staff have been diverted to covid-19 efforts. I believe the covid-19 vaccination (which now looks as if it will be ongoing for a long time) needs to be separated from general practice. Fundamentally primary care feels like it needs more hands on deck in surgeries. Actions to protect staff and patients from the consequences of excess workload are urgent and I think require centralised direction and funding. Mandating maximum patient contacts per day and establishment of centralised overflow capacity to make this feasible would be a step in the right direction. Whilst productivity may appear to decrease safety, recruitment and retention could all benefit.

I fear that in the coming years there will be even more significant staff shortages as retention in both nursing and doctor roles fails. I also fear that the only viable response in many areas will be large scale mergers of practices, or centralisation of some services at the very least. Large practices are not a bad thing, but pose particular challenges in terms of preserving patient continuity. Continuity of care has clear advantages for both patient care and staff morale. There is also a significant risk of smaller rural practices ending up disadvantaged by the drive to larger groups of practices. Active steps should be taken to preserve smaller sub-units of staff looking after small known populations, I think small groups of clinical staff may be more important than a named single GP. Traditionally the partnership model has facilitated this, but it is reasonable to ask if this now remains fit for purpose.

I am personally not wedded to the partnership model, as partnership and the current contract currently stand I think it:

This said moving to a salaried model with community, primary care and secondary care all employed by the same provider (or under the umbrella of in ICS), would be a deeply divisive move.


Dr Rowan Jones BSc (Hons) MB BCh MRCGP


Dec 2021