BMA demands end to micromanagement of general practice in meeting with Hancock

BMA GP leaders have warned the health and social care secretary about 'extreme pressures' facing general practice - and demanded an end to 'micromanagement' after NHS England told practices to offer all patients face-to-face appointments.

Portcullis House, Westminster (Photo: Andres Garcia M/Getty Images)
Portcullis House, Westminster (Photo: Andres Garcia M/Getty Images)

Health and social care secretary Matt Hancock told the House of Commons on 27 May that he had met with BMA leaders that morning 'to talk about what more we can do to strengthen access' to general practice.

The meeting came just days after the BMA wrote to Mr Hancock to demand an urgent meeting - warning that the profession was facing 'unrealistic demands' over face-to-face appointments at a time when workload was at an unprecedented level - and demanding more support from the government and the NHS leadership.

The BMA letter said an instruction from NHS England that practices should 'respect preferences for face-to-face care' showed a 'worrying disconnect with the reality facing general practice' and had created 'widespread anger, frustration and disappointment'.

Face-to-face appointments

More than half of GP consultations during the pandemic have been delivered face-to-face, in addition to millions of in-person contacts as part of the COVID-19 vaccination programme - and the rise in remote care during the pandemic was expressly backed by NHS England guidance that told practices to adopt a 'total triage' model.

Meeting Mr Hancock and health minister Jo Churchill, BMA GP committee chair Dr Richard Vautrey, along with BMA chair Dr Chaand Nagpaul and GP sessional committee chair Dr Ben Molyneux warned that general practice is facing 'unsustainable workload pressures'.

They called for more support for practices to enable an increase in face-to-face appointments at a time when the profession is handling a huge cohort of patients whose NHS treatment has been held up by the backlog triggered by the pandemic.

The BMA representatives warned that GPs working 'tirelessly' to manage huge demand should not face 'demoralising' claims they are failing patients by simply following guidance around remote care intended to keep patients safe.

GP workload

Dr Vautrey said: 'We are very pleased that Matt Hancock and Jo Churchill recognised the importance of meeting with us and the extreme pressures currently facing general practice.

'The BMA believes that GPs should feel empowered to deliver care in what they believe is the best way for their patients, and retain flexibility of access - be it in-person or remotely - rather than submitting to arbitrary targets of face-to-face appointments that may not meet the diverse needs of patients, increase workload and waiting times, and ultimately diminish the quality of care we can provide.

'The emergency legislation, which led to the top-down directives currently governing general practice, must be removed, and steps taken to help us work smarter, not harder, in what is already an extremely pressurised environment. This means creating a defined recovery phase for primary care, as well as an investment package to give practices the confidence they need going forward, rather than getting bogged down in being micromanaged by NHS England and scrutinised over the number of in-person appointments.

'It’s hugely encouraging that government is listening and taking this issue as seriously as we are – even going on to refer to our meeting in the House of Commons today - but it’s clear that this must now go beyond words and turn into action. We have fulfilled our promise to members that we would speak to the government as soon as possible to rectify this situation, and now look forward to doing so.'

COVID-19 pandemic

Dr Molyneux added: 'GP surgeries and GP urgent care services have continued to provide face-to-face appointments during what has been an extremely challenging time, but the profession is tired of command and control instructions that don’t take into account the reality of what it is to be a GP during a global pandemic.

'Seeing patients face-to-face is what general practice is all about, but we need meaningful support to reduce the current workload pressures facing GPs and their teams. Most importantly, we need the acceptance that GPs know their patients best and that our communities ultimately benefit from flexible access, be that face-to-face or via alternative means preferable to the patient.'

A DHCS spokesperson said: 'We are incredibly grateful for the tireless efforts of GPs and their teams over the past year.'

The spokesperson pointed to £150m allocated to general practice through the 'COVID capacity fund' up to March this year, and a further £120m that will be rolled out between April and September.

The spokesperson said: 'The government is providing an extra £270m to GPs to help manage the increased demands and ensure they can continue to support all patients. Cancer diagnosis remains a top priority, with urgent cancer GP referrals in March at the highest recorded level, and no one should be deterred from seeking help.

'As we build back better from the pandemic, we are committed to growing the primary care workforce and are supporting general practices to provide an extra 50m appointments a year by 2025.'

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