Dr Maureen Baker: What NHS England needs to do for general practice

The RCGP chairwoman sets out what the college wants to see in NHS England's package of support for general practice, which is due this month.

General practice is under pressure. We are seeing more patients every day than ever before. Our patients are increasingly presenting with more complex physical and mental health conditions. Our workforce is nowhere near growing at the rate of demand. And the resources available for our services has been depleting over the last ten years.

We’ve made our case. Now we need action to be taken to secure the future of our profession, the long term sustainability of our NHS, and the safety of our patients.

But we also need urgent measures, and NHS England is promising a number of initiatives to support our profession now, and put us on a stable footing for the future.

This is what the college wants included.

GP workforce crisis

Firstly, we need to tackle our workforce crisis. Practices are struggling to fill vacancies, and it is no wonder considering the pressures we are under.
Through the joint ten point plan, launched last year by the college with NHS England, Health Education England, and the BMA, we have seen the roll out of recruitment campaigns, incentive schemes to attract trainees to work in under-doctored areas, and a more streamlined induction and refresher scheme to make it easier for trained GPs to return to life in practice after a career break, or period working abroad.
But these long-term solutions are not going to see results overnight. We need our workforce problem to be addressed as a matter of urgency.
We want to see the creation of resilience teams that can be ‘parachuted’ in to practices struggling to fill staffing gaps. These would include GPs – perhaps recently retired – but also practice nurses and managers, and they would provide short-term relief and advise on long-term solutions for practices.

Support for other health professionals

We also need to tackle the workforce issues in practice nursing. I don't know where we would be without our practice nurses; they offer us invaluable support and play a huge role in keeping our patients safe, but the pressures we face not only affect us, but our teams as well. And whilst we know that former nurses are keen to get back into the workforce, it makes sense that we make this as easy and stress-free for them as possible.
We’d also like to see a pilot scheme for medical assistants – a role that has been successful in America, but hasn’t been tried here – to support GPs with our ever-growing and burdensome administrative duties that we simply don’t have time for at the end of a full-day in clinic.
As we strive for parity of esteem between physical and mental health – with 23% of ill health in the country being psychological – we need to see every practice have easy access to trained mental health workers, so that our patients can access their important and effective services when they need them, not 28 days or more later. With the upcoming publication of the government’s Mental Health Taskforce report expected, we would like to see this incorporated in some form.

Out-of-hours improvements

We also need to urgently tackle our out-of-hours service. For too long, it has been overlooked and under-resourced to the point where our patients don’t know where to turn.

Our GP out-of-hours service should be high-quality, accessible, and well-integrated with our routine five-day service; and as part of this we want to see the development of IT systems that will give GPs access to patient records around the clock.
On the topic of out-of-hours care, current costs to GPs of indemnity are out of control and are certainly acting as a barrier to GPs being able to work in extended or out-of-hours services. We want to see the introduction of a scheme whereby GPs who undertake more than 100 out-of-hours sessions a year receive a bursary towards their professional indemnity cover.

Digital grants

Finally, we need support to further embrace technology in general practice through digital grants that would allow practices to upgrade IT  infrastructure and equipment, which would both improve cost-effectiveness and our patients’ experience in the long-term
This ‘wish list’ might sound ambitious, but it’s viable and the college has produced – and shared with NHS England – realistic costings for how it would work. And whilst it might sound like a lot, it is necessary in order to keep our profession sustainable and our patients safe.
We urge NHS England to take note and send the ‘cavalry over the hill’ to help general practice, and our patients, now.

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