Viewpoint: The letter NHS England should have sent to GPs

NHS England caused fury after it issued a letter blanket demand that all patients should be offered face-to-face consultations if they choose. Dr Louise Hyde, a GP with the Doctors’ Association UK, sets out the letter NHS England should have written.

Dr Louise Hyde
Dr Louise Hyde

The mood among general practice peams has never felt so low following the letter from NHS England at the end of last week saying that all patients should be offered face-to-face consultations if they choose.

As we all know, general practice has never been closed and is now working harder than ever before in its history. Here’s what a letter from NHS England should have said:

Dear GPs,

Thank you for your dedication and hard work throughout the pandemic. We recognise that you are now dealing with higher levels of demand than we have ever seen before in general practice, and we are aware that you have increased your capacity to perform 3m more consultations in March this year than in March 2019, without any additional resources or funding.

We are grateful for your continued efforts in delivering the biggest vaccination programme the UK has ever carried out.

We recognise that you and many of your staff have pushed yourselves to near breaking point and are exhausted. We also understand how demoralising it feels when in spite of your best efforts it is impossible to meet this unprecedented demand, and this is compounded by constant media criticism of your efforts.

At the start of the pandemic in March 2020 you rose to the challenge and transformed your access arrangements overnight to ensure the safety of all patients who needed GP care.

At that time, and again during the second wave, it was clear that total remote triage was the safest option for all practices across the country. We are cautiously optimistic that we are now emerging from that time of national crisis, and we feel we can safely encourage practices to re-examine their access arrangements and make their own decisions based on the individual circumstances of their practice. Total remote triage is no longer compulsory.

We know that GPs are experts in dealing with uncertainty, balancing risk, and responding to evolving situations, and that you know your individual practice populations better than anyone else. We trust you to make the right decisions for your practice and we will support you in your choices.

We are exploring a range of interventions which aim to help ease the burden on General Practice in the coming months. These include:

  • Urgently addressing the waiting list problem in secondary care
  • Urgently addressing the diagnostics problem in secondary care
  • Investing in acute care, increasing the staffing of A+E and improving access to beds in hospital for sick patients and troubleshooting the problems of patients being sent home too soon
  • Ensuring that workload shift from secondary care is reversed, or where this proves impossible, at least fully funded under a formal contract to allow the taking on and training of staff to carry it out
  • Ensuring that on-line access systems can be time-limited by the practice in whatever way best suits their ways of working and the needs of their patient population
  • Dropping all targets that don’t lead to evidence-based improvements in clinical care from the contract
  • Giving an additional boost of funding just to allow doctors to consult with patients, without any additional tick-boxes attached
  • Recognising the likelihood that the vaccination programme is likely to be ongoing due to the growth of vaccine resistant strains, and increasing funding to allow training and retention of additional staff
  • Addressing the massive shortfall in mental health care for the whole population and encouraging the government to invest in a large scale programme to dramatically increase capacity, recruit and upskill staff, and ensure that evidence based therapy can be delivered in a timely way to every patient who needs it
  • Secure funding to enable every doctor to take an additional break this year, and to ensure that their workload is fully back-filled while they are away
  • Ensure that the provision of mental health resources for doctors is raised to meet the highest standards across all trusts
  • A media campaign in support of GPs, including education of patients to make wise choices in how they seek healthcare, and countering common misconceptions, such as surgeries being closed or an examination always being an essential part of a consultation

We welcome your suggestions for solutions to the current challenges and are committed to supporting GPs through one of the hardest times the profession has ever faced.

Yours sincerely,

Dr Fantasy and Mr You-should-be-so-lucky, on behalf of NHS England

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