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January 2022

Omicron causes increasing pressure on NHS but general practice overlooked – again



BMA leaders have warned that general practice is being overlooked in Government discussions about pressure on the NHS caused by the increasing rate of omicron infections.

BMA GP committee chair Dr Farah Jameel said ‘It won’t have gone unnoticed that the Prime Minister in his speech earlier this month talked about rising hospital admissions when he talked about pressure in the NHS, leaving us in general practice as the forgotten soldier yet again.

‘This was then further compounded by the Labour leader Sir Keir Starmer saying “good luck to anyone trying to get a quick GP appointment”.’

Responding to Sir Keir’s remarks, Professor Martin Marshall, Chair of the Royal College of GPs, said: ‘GPs are just as frustrated as our patients when they have difficulty accessing an appointment quickly, but our teams will always do our very best to make sure those most in need receive timely, safe and appropriate care. We want to be able to deliver the care that patients need when they need it, but more than a decade of underinvestment in general practice, and historic poor workforce planning, has resulted in a significantly overstretched workforce. General practice was struggling before the pandemic, but the crisis has only exacerbated the intense workload and workforce pressures we are working under.

‘Current pressures in the NHS are not confined to hospitals. General practice has been working to its limits and still faces tough months ahead, which won't be helped by high numbers of staff falling sick or having to isolate due to testing positive for COVID.

‘GPs and our teams are working exceptionally hard to deliver good, safe and appropriate care to our patients. More than 34 million consultations were delivered in November – the highest monthly number on record. We have also played a vital role in the COVID booster vaccination programme, working with colleagues across the NHS to deliver almost a million vaccinations a day towards the end of December.’

Dr Jameel pointed out that general practice carries out a million consultations a day, and issues 7 million prescriptions a week. ‘If general practice was to fall over, a rough estimate tells us that at the very least, 14 million patients would lose access to care in just one week. This is the impact that will ripple across the healthcare system and the sheer scale of care that you in general practice provides.’

A BMA snapshot poll carried out earlier in January found one in five of almost 6,000 GPs who responded had had to isolate due to COVID-19 during the preceding 2 weeks. More than two-thirds (69%) said staff absences had impacted patient care, with many stating that the impact was significant.

Prioritising workload

The BMA and RCGP have published joint guidance on prioritising workload in response to the rising number of omicron cases. It says ‘there is no one size fits all blueprint for how practices should operate or what measures should be taken to manage daily workload. While the NHS as a whole is under unprecedented pressure, patients who do not seek care for long term conditions or newly developed, potentially serious, symptoms can place themselves at a level of risk which, for some, is as significant or higher than the risk from COVID-19.

‘GPs and their teams will need to make difficult decisions…It is essential that the workforce does not become burnt out [but] whatever steps we take, we must reassure the public that general practice remains open.’

Current clinical priorities include (but are not limited to) providing urgent care for acutely unwell adults and children following initial remote assessment; contraceptive services; childhood immunisations; flu vaccinations; medication problems; cancer or suspected cancer.

Activities that could be postponed include routine non-urgent screening; all non-essential paperwork; non urgent investigations and non-essential procedures.

The guidance is available at https://www.rcgp.org.uk/covid-19/latest-covid-19-guidance-in-your-area.aspx#workload

Practice Nurse 2022;52(1):6