Face-to-face care debate 'too polarised', says NHS England's top GP

The face-to-face care debate has become 'too polarised', NHS England's top GP has warned - urging GPs to 'stay close' to patients to avoid a wedge being driven between practices and communities.

NHS England primary care medical director Dr Nikki Kanani

Appearing at the RCGP annual conference 2021 in Liverpool as part of a Question Time-style panel, NHS England primary care medical director Dr Nikki Kanani said general practice had never faced a more difficult time.

Speaking a day after the publication of a much-criticised plan from the government and NHS England that ramps up pressure on GPs over face-to-face access, Dr Kanani said the problems facing general practice were complex and there was 'no silver bullet' to resolve them.

She said it had been crucial to 'buy ourselves some time over the coming months', and to do something to support the general practice workforce while making sure patients receive the care they need.

Face-to-face access

She said the debate around face-to-face access had become too polarised, and that although the NHS was built on a principle of need [for healthcare] rather than want, it remained important to take other factors into account.

Some patients had been offered the care they need by telephone, but still needed to see a healthcare professional, she argued. Dr Kanani said it had to be made clear that face-to-face appointments may not always be with a GP, but also with other capable members of the primary care team.

Dr Kanani added: 'One thing we need to do is stay really close to our patients on this - the minute we get a wedge between general practice and our patients we lose our ability to have a really strong relationship based around continuity of care, and that's what we're really good at.'

The NHS England primary care medical director added that she endorsed measures in the plan setting out a zero tolerance policy on abuse of NHS staff. She told the conference: 'We should not and must not tolerate the sort of abuse and violence that all NHS staff, but particularly general practice colleagues [have experienced'. Tougher sanctions for that are right.'

Care based on needs

She added that updated advice on infection prevention and control talked about the value of face-to-face care but also of remote care - and about seeing patients 'based on needs'. 'Fundamentally it says do what you need to look after patients,' she said.

RCGP chair Professor Martin Marshall criticised the plans put forward by the government and NHS England, and said the 'diplomatic answer was that they were disappointing'. He said the plans 'don't address the key problem that demand outstrips supply', and criticised the 'politics of giving with one hand and taking away with other'.

He said it seemed 'bizarre' that funding attached to the plans may be denied to practices deemed to be the worst-perfoming, when those very practices may be the ones that need it most.

The East London GP said: 'Quite a few of my colleagues are older Asian doctors working in small practices, generally and understandably worried about COVID-19 and they are the people who won't get the support but who most desperately need the support.'

Name and shame approach

He also criticised the 'name and shame' approach set out in the report around plans to roll out a new patient satisfaction measure.

Dr Becks Fisher, a GP and senior policy fellow at the Health Foundation think tank, said it was clear that whatever plan had been unveiled this week could not have addressed the problems facing general practice in full.

She said: 'If we think about what has happened over past 10 years, I think the NHS has been undervalued and general practice in particular has been undervalued. What we need was not on offer - we need a comprehensive workforce plan…we needed better funding over the last 10 years and we are paying the price for that now. We need government, the prime minister and the secretary of state to have a major change of heart.'

Asked how the profession could develop a relationship with Sajid Javid after he cancelled an appearance at the RCGP conference, Dr Fisher agreed that it was challenging but echoed the warning about not allowing a wedge to be driven between GPs and patients by 'sections of the media and politicians'.

Sheffield GP Dr Aarti Bansal told the conference that the plans for general practice were 'laughable' - warning there seemed to be a 'really fundamental misunderstanding of what general practice does' at the top of government. She said it was important for GPs to articulate that better and explain the model and the importance of continuity of care better to make the case for investment.

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