Blueprint for GPs is a “missed opportunity to improve intense pressure” on primary care

A new blueprint for improving access to GP appointments has been seen as a missed opportunity that will do little to improve the intense pressures on primary care, according to the Royal College of GPs (RCGP).

The government announced that surgeries will be provided with additional funding to boost face-to-face appointments as part of a major drive to support general practice and tackle abuse against staff.

It said the measures, including a £250 million winter access fund from NHS England to help fund locums, will enable GP practices to improve availability so that patients who need care can get it, often on the same day if needed.

The RCGP, however, said that although additional financial support for patient care in general practice is always welcome, a focus purely on access ignores the other challenges it faces in providing high-quality, personalised care.

Long-standing workforce pressures facing general practice

Professor Martin Marshall, Chair of the Royal College of GPs, said: “Crucially, there is also nothing here to address the long-standing workforce pressures facing general practice. We need the Government to make good on its manifesto pledge of an additional 6,000 GPs, and 26,000 other primary care professionals, to enter the workforce by 2024.

“The RCGP has always been very clear that a blend of remote and face-to-face consultations are necessary, and that post-pandemic this should be a shared decision between GP and patient. We know some patients prefer to see their GP face to face – but good care can and is being delivered remotely and some patients prefer it.”

The College added that reducing the burden of QOF on practices would have been a positive step forward, and it was disappointed not to see this.

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.

As part of this package, the NHS will increase its oversight of practices with the most acute issues in relation to access, and GP appointment data will be published at practice level by spring next year. This will enhance transparency and accountability, as monthly data is currently only published by clinical commissioning group.

Text messages to rate GP practices’ performance

In addition, patients will get the opportunity to rate their practice’s performance, via text message, based on their most recent experience of accessing support. This survey, which has been previously agreed with the profession, is being piloted in around 60 practices and will be rolled out next year.

The RCGP said it was particularly concerned at plans to increase the scrutiny of hard-pressed practices and the introduction of an arbitrary text message service to rate the performance of particular GP practices. There are already ways for patients to feed back on their experience – the introduction of more measures will further demoralise a profession that is already on its knees, and demonise practices that are struggling.

NHS England will also work with the government to consider how far and fast the role of pharmacists can be increased in the supply of medication, as part of relieving workload on GPs.

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. I also want to thank GPs and their teams for their enormous efforts in the most challenging times in living memory.

“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.”

Intelligent conversation about variety of appointments is needed

The British Medical Association (BMA) said it was disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments. It said a more intelligent conversation is needed about the variety of appointments and care that are available to patients to meet their needs.

BMA GP committee chair Dr Richard Vautrey said: “After weeks of promising an ’emergency package’ to rescue general practice, we’re hugely dismayed that whilst additional funding has been promised, the package as a whole offers very little and shows a Government completely out of touch with the scale of the crisis on the ground.

“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.”

He added that the additional £250m is welcome but it must be easy for practices to access rapidly and they must not be forced to have to produce reams of plans or try to meet unattainable targets to get it  – which has often happened in the past.

“We had four simple asks – and only one appears to have been fully answered,” he said. “Increased sentencing for assaulting healthcare workers is something we asked for, but meaningless if the same Government refuses to address the crisis fuelling such abuse.  The Secretary of State has started to address a second, by talking more positively about general practice but he needs to do much more to publicly support the profession when we are under such pressure and facing a torrent of abuse on a daily basis.

“These proposals will only confirm the profession’s belief that ministers and NHS England fail to understand the dire state of general practice – or that they, not hardworking GPs, are to blame. It’s truly frightening that we have a government so ignorant to the needs of such a core part of the NHS. GPs want to improve the care we offer to our patients, but today’s offer will not enable us to do that as we had hoped.

“GPs across England will be truly horrified that this is being presented as a lifeline to general practice, when in reality it could sink the ship all together. There can be no doubt that this lack of action at such a critical time will force many GPs to hang up their stethoscopes and leave the profession for the last time.”