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Government’s “rescue package” will prompt more GPs to quit, leaders warn

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2517 (Published 14 October 2021) Cite this as: BMJ 2021;375:n2517
  1. Gareth Iacobucci
  1. The BMJ

A new government blueprint designed to improve access to general practice will prompt more doctors to quit and shows that ministers are “completely out of touch” with the scale of the crisis in the profession, GP leaders have warned.

The plan,1 published on 14 October by the Department of Health and NHS England and NHS Improvement, pledges an extra £250m to increase the proportion of appointments practices deliver face-to-face and tackle the “unacceptably poor access to general practice” experienced by some patients.2

“A minority of practices are now offering wholly inappropriate access, with very low levels of face-to-face care,” the document said. “In August 2021 over 15% of practices recorded less than 20% of their GP appointments being held face-to-face. That is likely to be contrary to good clinical practice, even if it were to reflect the preferences of their patients.”

The plan proposes a series of measures to boost access including:

  • - Requiring practices to complete a review of whether they have “got the balance for patients right between remote and face-to-face consultations” by the end of October

  • - Requiring local commissioners immediately to start identifying the 20% of practices in their area that have the lowest level of face-to-face appointments

  • - Withholding additional funding from practices that do not provide appropriate levels of face-to-face care

  • - Asking practices offering “unacceptable access” to partner with other practices, federations, or primary care networks or face “contract sanctions and enforcement”

  • - Supporting upgrades to GP telephone systems

  • - From April 2022, automatically sending text messages to patients after appointments asking them how they rate their access.

Richard Vautrey, chair of the BMA’s GP committee, said that while the funding was welcome, he was “dismayed” at the tone and content of the plan, which failed to tackle high levels of bureaucracy that is putting access and care at risk.

“These proposals will only confirm the profession’s belief that ministers and NHS England fail to understand the dire state of general practice—or that they, not hardworking GPs, are to blame,” he said. “It’s frightening that we have a government so ignorant to the needs of such a core part of the NHS. GPs want to improve the care we offer to our patients, but today’s offer will not enable us to do that as we had hoped.”

He added, “GPs across England will be 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.”

Royal College of GPs chair Martin Marshall was similarly scathing about the plans. In his opening speech to the college’s annual conference in Liverpool, he said, “The so-called support package is most definitely not the answer to the challenges that we face in providing high quality care for our patients. Calling today’s announcement a missed opportunity would be the understatement of the century.”

Practices will be able to access the extra investment through local commissioners to help them pay for locums, support staff, or extra sessions from existing staff. The money will also be available to expand same day urgent care capacity through other services this winter.

The plan also promises to launch a “zero tolerance” campaign of abuse against healthcare staff, and to legislate for the maximum prison sentence for common assault to be doubled to two years if the victim is an NHS worker.

Health 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.”

But Vautrey condemned the government’s “preoccupation with face-to-face appointments” and called for “a more intelligent conversation” about how care is delivered.

“The pandemic has proven that in many cases phone or video appointments are entirely appropriate and appreciated by patients, and a crude focus on percentages or targets is completely unhelpful,” he said.

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