GP fury as 'support package' ramps up pressure on face-to-face access

Government plans billed as a 'support package' for general practice threaten a fifth of practices with direct intervention over face-to-face appointments and fail to provide the assistance the profession desperately needs, GP leaders have warned.

Health and social care secretary Sajid Javid (Photo: Christopher Furlong/Getty Images)

GP leaders said they were 'dismayed' that after promising support for general practice, officials had rolled out a package that 'offers very little' - warning it showed a government 'completely out of touch with the scale of the crisis on the ground'.

The BMA said it was 'truly frightening that we have a government so ignorant to the needs of such a core part of the NHS'. Speaking at the RCGP annual conference in Liverpool, college chair Professor Martin Marshall said the 'so-called support package was most definitely not the answer'.

Plans set out by the government and NHS England include a £250m winter access fund, to be rolled out between November this year and March 2021. The funding is explicitly linked to demands for practices to deliver more appointments overall - at a time when the profession is already delivering more than ever before - as well as demands for more appointments face-to-face.

QOF targets

The plans will also create new QOF targets on access for GP practices, and could bring the rollout from April 2022 of a new patient satisfaction system that will invite patients to rate their practice by text after an appointment.

Satisfaction scores will be published at individual practice level alongside practice-level data on 'activity and waiting times', the plans confirm. Practices will be incentivised under the Investment and Impact Fund to increase their satisfaction scores in 2022/23, with the scale of incentives to be 'increased significantly in 2023/24'.

GP leaders warned the plans threatened to drive up pressure on general practice - and could lead to yet more abuse in the wake of sustained attacks over face-to-face access. The plans come just weeks after GPs hit out at the government for 'singling out' general practice for pay transparency measures that will not apply to any other NHS employees or contractors - despite promises that GPs would not be unfairly targeted.

The plans also heap further pressure on general practice over face-to-face access despite appeals from the profession for greater support.

Face-to-face access

Practices have been ordered to complete reviews by the end of October looking at whether they have 'got the balance for patients right between remote and face-to-face consultations'. A further 200 practices will receive support through the NHS 'access improvement programme' - on top of 700 already being supported.

In addition to this, England's 44 integrated care systems (ICSs) have been told to begin an 'immediate exercise' to build a list of up to '20% of all local practices, where [they] will be taking immediate further steps to support improved access'.

Practices in line for this intervention will be those identified as being in the bottom 20% for the proportion of appointments delivered face-to-face, where A&E usage is highest, where overall appointment numbers have dropped compared with pre-pandemic times and where calls to 111 from their patients are high in core hours.

The document setting out the proposals hails GP practices' response to the pandemic, and says 'all practices are currently grappling with the emergent challenge of working out the optimal blend of face-to-face appointments alongside remote appointments'.

Patient preferences

Many are doing so 'brilliantly' the document says - but it claims that 'a minority of practices are now offering wholly inappropriate access, with very low levels of face-to-face care'. It says that in August this year 'over 15% of practices recorded less than 20% of their GP appointments being held face-to-face - a level 'likely to be contrary to good clinical practice, even if it were to reflect the preferences of their patients'.

The £250m winter access fund will allow practices to pay existing staff for extra sessions, bring in additional locum or other support. Health systems pitching for a share of the fund must demonstrate that all practices are delivering 'at least pre-pandemic activity levels', the document says - despite evidence from official data and RCGP surveillance figures showing practices are currently delivering significantly more appointments overall, as well as a massive surge in clinical administrative workload.

Systems must also show they are increasing appointment volumes in general practice, increasing the proportion delivered face-to-face, minimising in-hours use of 111 and A&E services - while practices must sign up to the community pharmacy minor illness referral service to receive a share of the cash.

The plans also promise 'zero tolerance' on abuse of healthcare workers, highlighting plans to double the maximum sentence for common assault against NHS staff.

Practice staff abused

Launching the package of plans, health and social care secretary Sajid Javid said he was 'determined to ensure patients can see their GP in the way they want, no matter where they live'. His comments come just weeks after he said it was 'high time' GPs delivered face-to-face appointments to all patients who want them - something the RCGP has told MPs is simply 'undeliverable'.

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.

'It is also disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments; we need a more intelligent conversation about the variety of appointments and care that are available to patients to meet their needs.'

He said the BMA had repeatedly told ministers that patient care and access would be at risk unless red tape for practices was cut back. But he warned: 'Unfortunately, today’s offer merely tinkers around the edges, and will not reduce the unnecessary burden practices carry.'

He said measures to ease pressure on GPs through widening the list of professionals that can provide medical evidence, fit notes and DVLA checks were a 'mere drop in the ocean'. He added: '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.'

RCGP chair Professor Marshall said: 'We knew we were unlikely to get a silver bullet to solve all the challenges GPs and our teams are facing, but we hoped to see more tangible solutions to improve the care that can be delivered to patients. Our hardworking members will see this package as a missed opportunity.

'A focus purely on access ignores the other challenges we face in providing high-quality, personalised care. 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.'

In addition to the lack of measures on workforce pressures, the report claims that full-time equivalent GP numbers rose by around 1,200 between June 2019 and June 2021 - although the fully qualified workforce rose by just 100 doctors. It also fails to acknowledge a huge underspend against additional roles reimbursement scheme targets.

Health and social care secretary 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.'

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