NHS England must 'switch off' admin pressure on practices

NHS England and CCGs should 'switch off' everything GP practices are required to do that is not related to frontline patient care, according to London's top GP.

Londonwide LMCs chief executive Dr Michelle Drage (Photo: Londonwide LMCs)
Londonwide LMCs chief executive Dr Michelle Drage (Photo: Londonwide LMCs)

Londonwide LMCs chief executive Dr Michelle Drage said the current situation in general practice was dire and that practices ‘need relief’.

She said that in the longer term system-wide change was needed to address the pressures on GPs, but in the short term cutting the administrative burden on practices would help.

‘The simplest thing that could help practices is to switch off all the stuff that isn’t to do with frontline care and is to do with the admin and the running of the service,’ she said.

‘I think that would be a massive message [for NHS England and CCGs] to give about how they care about frontline practices being able to look after their patients. Just switch it all off and that would mean stopping all of the pressure that is on GPs, practice managers and practice nurses to tick boxes.’

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Dr Drage acknowledged that the healthcare system around general practice was important. But she said that for GPs and nurses the most important thing was having the time to look after their patients, ‘and those two things don’t necessarily sit neatly together’.

Streamline regulation

The NHS should ‘stop trying to contractualise to the nth degree every single bit’ of the work that GPs do, she added. ‘Because that nails you into a corner and a coffin at the same time - you don’t have the flexibility and autonomy to do the core job and that’s the real problem.’

Dr Drage said that the driver for much of the administrative work practices were subject to was a ‘political need to be showing that the NHS is being transformed’.

‘Requiring the people doing the job to tick all the boxes that the NHS needs to be assured of the things it’s got to deliver to the politicians is what’s causing the pressure. That plus the regulatory environment.’

She said CQC inspections, revalidation and appraisal could all be streamlined and made easier for practices to manage.

‘I think it’s in [NHS England’s] gift to do something about it. In the short term it could be done,’ she said.

GP burnout

GPs ‘not being able to do the job they’re trained to do and not being able to do the job properly’ was the biggest issue contributing to rising levels of burnout in the profession, Dr Drage said.

GPs and nurses are ‘scared because they’re being pressurised to do stuff from the top, they’ve got demand from the bottom and people tell me they’re forever looking over their shoulder,’ she added.

‘They’re scared to act, scared to not act. They’re pinned down. And for even the best survivors that is unhealthy for them and hence they get burnout.’

She said that schemes aimed at addressing mental health issues in doctors were like ‘slapping bandaids on’. ‘That’s shutting the stable door after the horse has bolted. You want to get there before that and that requires system changes.’

GPs were ‘by their very nature resilient’, she added. ‘If they get through medical school and training, they’re resilient. If you’re being told you need to be made more resilient then there’s something wrong with the system.’

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