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October 2021

Blueprint for general practice a 'cause for dismay'

The Government’s ‘Blueprint for improving access’ was presented as a lifeline for general practice but has been condemned by GP leaders as the last straw, which could 'sink the ship altogether'.

The NHS, working closely with the Department of Health and Social Care, claims the plan is designed to support GPs and their teams. But as well as promising additional funding to boost practices’ capacity to increase the proportion of appointments, the document threatens remedial action for up to one-in-five practices who do not deliver ‘appropriate’ levels of face-to-face patient contact.

BMA GP committee chair Dr Richard Vautrey said: ‘After weeks of promising an “emergency package” to rescue general practice, we’re hugely dismayed that while additional funding has been promised, the package as a whole offers very little.

‘GPs and their teams will now be facing the worst winter for decades, and as a result, patients’ care will suffer. Appointments will be harder to book, waiting times will get longer, more of the profession could leave and GPs will struggle to cope.’

The £250 million winter access fund from NHS England will enable GP practices to improve availability so that patients who need care can get it, often on the same day if needed. NHSE said: ‘The investment will fund locums and support from other health professionals such as physiotherapists and podiatrists, with a focus on increasing capacity to boost urgent same-day care. This is in addition to £270 million invested over the previous 11 months to expand capacity and support GPs.’

Dr Vautrey said: ‘It is disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments. While in-person consultations are a key feature of general practice and absolutely necessary for some patients and certain conditions, the pandemic has proven that in many other cases, phone or video appointments are entirely appropriate and appreciated by patients, and a crude focus on percentages or targets is completely unhelpful.’

The blueprint comes in the wake of the Government’s own figures which showed that practices already saw more patients in August – some 60% face-to-face – than in previous months, and 6% more consultations in September than in the same period in 2019.  According to an analysis of RGCP figures, practices delivered 71 extra appointments per 10,000 patients in a 2-week period, equivalent to 1million extra appointments a month. Including telephone and online appointments, general practice is seeing 5-10% more patients than before the pandemic.  

Secretary of State for Health and Social Care, Sajid Javid said: ‘I am determined to ensure patients can see their GP in the way they want, no matter where they live.

‘Our new plan provides general practice teams with investment and targeted support. This will tackle underperformance, taking pressure off staff so they can spend more time with patients and increase the number of face-to-face appointments.

‘Alongside this we are setting out more measures to tackle abuse and harassment so staff at GP surgeries who work so tirelessly to care for patients can do so without having to fear for their safety.’

The NHS England document makes clear that every GP practice must seek patients’ input and respect preferences for face-to-face care unless there are good clinical reasons to the contrary. The plans will also introduce new QOF targets for access to GP practices, and, from April 2022, roll out a new system to enable patients to rate their satisfaction with their practice, after an appointment, by text. Scores will be published at individual practice level together with practice-level data on activity and waiting times. The 20% of practices in each area with the high rates of 111 calls and A&E attendances will face ‘direct intervention’.

Other proposals include:

  • Upgrades to telephone systems, ensuring that more patients can quickly and easily speak to general practice staff, and help the public avoid long waits when contacting a surgery by phone.
  • Reducing administrative burdens on GPs by reforming who can provide medical evidence and certificates such as FIT notes and DVLA checks – freeing up time for more appointments.
  • The UK Health Security Agency (UKHSA) will complete its review of infection prevention and control (IPC) guidance in general practice and set out practical steps on IPC measures in GP settings which could increase the number of patients that can be seen.

The blueprint acknowledges that general practice teams have delivered more than 300 million appointments over the last year as well as ‘delivering the vast majority of COVID vaccinations, saving lives and protecting millions of people against the virus at speed.’

Dr Vautrey added that practices would be ‘truly horrified that this is being presented as a lifeline to general practice when in reality it could sink the ship altogether. There can be no doubt that this… will force many GPs to hang up their stethoscopes and leave the profession for the last time.’

NHSE. Improving access for patients and supporting general practice; October 2021 

Mandy Galloway
Practice Nurse 2021;51(9): online only