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The waiting game

Extending GP access forms part of major NHS consultation on future of general practice

GPs face providing more appointments in the evening and at weekends, under NHS England suggestions on how to address ‘growing dissatisfaction’ with access to practices put out for consultation today.

The major public consultation on the future of general practice asks for suggestions on how to stimulate ‘more convenient routine access to GP services’ and improve ‘the speed of contact for urgent problems’.

It also asks for opinions on how to ‘strengthen accountability’ for the quality of out-of-hours care and on how to take forward health secretary Jeremy Hunt’s plans for a ‘named GP’ for patients with complex needs.

The consultation calls for ideas on how general practice can operate at ‘greater scale’, while protecting continuity of care, with stronger incentives for inter-practice collaboration and other providers in primary, secondary and social care included in the GP contract.

GP leaders have cautiously welcomed the plans, but warned that any rise in workload will require increased funding for general practice.

The document marks the first details on a ‘fundamental review’ of how practices are paid first revealed by Pulse in May.

The governing body for the NHS says that the consultation will explore ideas to make GPs play an ‘even stronger role at the heart of more integrated out-of-hospital services’ and deliver better health outcomes and more personalised care.

NHS England says that though a recent engagement with GPs, CCGs and other partners it has identified a number of areas that mean GPs face ‘increasingly unsustainable pressures’ and need reform.

These include the impact of an ageing population, growing co-morbidities and increasing patient expectations and increasing pressure on NHS financial resources, which will intensify further from 2015/16.

It also cites ‘growing dissatisfaction with access to services’ and a two-fold variation in GPs and nurses per head of population between more and less deprived areas.

The call comes after a report, drawn up jointly by the Nuffield Trust and King’s Fund think tanks, suggested that NHS England introduces a brand new contract ‘in parallel to the GMS contract’ to incentivise GPs to form networks or larger groups to provide services to improve mental health, elderly care and social care.

The consultation says: ‘The main purpose is to stimulate debate in local communities, among GP practices, CCGs, area teams, health and wellbeing boards and other community partners, on the best way to develop general practice services. 

‘NHS England is also inviting comments about how it can best support local changes, for example through the way national contractual frameworks are developed.’

It asks a number of questions in order to address the problems with general practice, including facilitating better access to GPs.

The document asks: ‘How do we stimulate more convenient routine access to general practice services, including ease of making appointments, speed of contact for urgent problems (whether telephone or face-to-face), ability to book less urgent appointments in advance, ability to communicate electronically (e.g. online consultations) and, particularly for working-age adults, availability of evening/weekend slots?’

It also asks for ideas on how to free up time and resources in general practice, promising to ‘root out bureaucracy and promote more productive practice’ and how to reform QOF to preserve its essential features but reducing the ‘tick-boxes’.

Pulse revealed in May that NHS England were considering radical proposals to scale back the size of the QOF to free up resources for more ‘creative’ ways of incentivising GPs to improve patient care.

The RCGP has welcomed the consultation, saying it was ‘much-needed’.

RCGP chair, Professor Clare Gerada, said: ‘It is very encouraging to see that the strengths of general practice and its position at the centre of the NHS are so readily acknowledged and that GPs, other clinicians and patients in their communities will have such a strong influence in the engagement process and the results it produces.

‘The College’s own 10-year vision for the future of primary care, The 2022 GP, already sets out many of the solutions we need to support and strengthen general practice for the future.

‘We hope that NHS England will help us turn our aspirations for patient care into a reality and that we can work together to bring about major investment in general practice - including 10,000 more doctors -  so that GPs can do even more for their patients in their communities.’

Dr Richard Vautrey, GPC deputy chair, said the document contained ‘a number of positive starting points’ that the BMA would be happy to discuss.

He added: ‘GPs, like all doctors, care deeply about the services they deliver to their patients and will continue to work hard to make improvements. In order to do this, we need to take a holistic approach that recognises all the pressures facing the NHS.

‘We need to recognise that rising workload will require increased funding for general practice as well as a commitment from the government to empower GPs, patients and other healthcare professionals to use their experience to help shape services in the future.’


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Readers' comments (42)

  • Call me cynical, but the phrase "Trojan Horse" comes to mind....

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  • Since 2004 GP resourcing has been gradually dropping to the the point where it has now become unsustainable and it is difficult to recruit enough GPs and nurses. What you are seeing is market forces at work and yet the government want to encourage more of it with AQP. At some point the demand will rise to the extent that it will choke the ability of primary care to function similar to the current A+E crisis but worse because we see 90% of the patients. The only solution is to introduce some form of demand control and increase supply of GPs and nurses by charging for consultations - this works well everywhere else in the western world.

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  • And look out for the usual Judas Goats...

    I expect to see the "needs reform" agenda taking precedence over addressing "increasingly unsustainable pressures".

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  • Watch out for a salaried service.
    Any failure to meet demand is caused by government raising the public's expectation ever higher.

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  • Have just paid a locum £5000 including superannuation for my 2 week annual leave this means locums earn £120000/year or 25% more than a partner who is shortly going to have to do on call again for the same income or less,the current model of general practice is about to collapse it is simple economics does NHS England care or is this a policy aim?

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  • Personally, I believe the system of primary care provision is no longer suitable & needs a radical overhaul - we still have the corner shop model of 1948, & constantly trying to prop this up with bits of money here & there is just making things worse. If we focus on service provision (in all sectors) tailored to patient pathways and best outcomes, we might get somewhere, but I wouldn't hold my breath.

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  • Well it's about time we tried to make "GPs play an ‘even stronger role" - maybe the whole system should be reformed at great expense with GPs as leads controlling billions of pounds of the commissioning budget....wait....

    I never understand consultations like this - if you ask everyone what they would like to see from GPs, they'll tell you that they want 24-hour, round the clock care, access to a GP by phone, email, videochat, home visits, referrals to consultants for everything, prescriptions for everything, and a cup of tea and a biscuit with every visit. It's just not feasible.

    It sounds like they're just trying to discredit general practice by making it seem like there are massive failings now.

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  • we need to change, the challenge is identifying which bits of the current model need keeping and which can be thrown away. the problem is that we may find that the 'chattering classes' who contribute to any consultation value convenience over quality, until its THEM that need the quality. quality tends to mean continuity and a Dr who knows you as an individual, although that may be my prejudice.
    general practice has stuck with the same model for 60+ years with some (relatively major) tinkering at the edges, salaried service, probably, but not if the gvt have any sense as it would just cost too much. they have underestimated the risk sink that is GP in the past have they learnt the lesson??

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  • @Adrian Canale-Parola As a patient, with my Big Opt Out off, I really could not give a flying stuff about "patient pathways and best outcomes" I want what is right for me as an individual. The NHS can keep its flaming nose out of the relationship between myself and my single handed GP and my medical records.

    We desperately need more single handed and small practices that can provide individual care to their patients.

    To be honest I would not, under any circumstances, want a large Practice nor do I want to see a GP in the evening/weekend. GP's have lifes too.

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  • Can we look t the model of Primary care provision of other european countries???

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