Intended for healthcare professionals

Opinion Primary Colour

Helen Salisbury: A poor plan for patients

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2315 (Published 27 September 2022) Cite this as: BMJ 2022;378:o2315
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}phc.ox.ac.uk
    Follow Helen on Twitter: @HelenRSalisbury

A new plan for the NHS was unveiled last week by the recently appointed secretary of state for health and social care, Thérèse Coffey.1 The service faces huge backlogs and a workforce crisis, so we’re ready to welcome any measures that might relieve the pressure. Sadly, Our Plan for Patients is long on rhetoric but short on detail, regarding what the health secretary will actually change.

There are admirable ambitions to empower patients and improve outcomes, but it’s not clear how any of them will be achieved. Where’s the detail in the promise of 7000 extra beds this winter? The NHS in England currently has 47 000 nurse vacancies,2 so the immediate and obvious question is, “Staffed by whom?” There’s an emphasis on improving productivity, but a friend of mine has commented that she’s already doing the work of two nurses, so I don’t know how much more can be squeezed out of an already exhausted workforce.

In general practice, the plan states that the government will “set the expectation that everyone who needs an appointment with their practice within two weeks can get one.” Currently, 44% of appointments happen on the day they’re booked and 85% within two weeks,3 although some areas clearly have problems with longer waiting times. We have a shortfall of 4200 full time equivalent GPs,4 and those we have regularly work 11 hours a day5 so it’s hard to see how setting an expectation will magically produce more appointments or what this odd statement aims to achieve.

One casualty of the emphasis on access is continuity of care. It may be much better for a patient to be seen a few days later, by a doctor who knows them well, than sooner, by one who has an available slot within the two week period but will have time only to skim read their notes. However, the real shame of this plan is in its language: the not-so-subtle pitting of patients against GPs as the government reassures patients that it’s on their side. I struggle to see who or what the government thinks is on the other side (apart from disease, suffering, and untimely death), but this looks suspiciously like a deliberate fuelling of the war on general practice waged through the media for the past few years. “The doctor MUST see you now!” bellows a headline from the Daily Mail,6 over an article with four references to Coffey’s “laser-like focus.”

None of this is helpful to doctors or our patients. Although there’s a welcome nod to pension reform, for many GPs considering early retirement (and there are many) this is not the main factor in their decision. Workload, bureaucracy, and above all a hostile environment mean that we’re losing colleagues faster than we can replace them, and the plan does nothing to tackle this. If the government was really on the side of patients it would pull out all stops to return us to an adequately funded, fully staffed NHS and social care sector. Alas, there are no signs that this is its intention.

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