Dr Chaand Nagpaul: ‘The goodwill of GPs is being exploited’
At Pulse Live in June, Dr Chaand Nagpaul talked to Pulse editor Nigel Praities about his first year as GPC chair, his hopes for the GP contract and whether Jeremy Hunt really cares about general practice.
What have been the highlights so far of being the GPC chair?
The most important thing has been getting back to the negotiating table. When I inherited this position, we had an imposed set of changes that we knew were going to damage care for patients. But 80% or 90% of those impositions have now been scrapped. We’ve communicated to the Government that it does not make sense to alienate GPs, or to impose demotivating obstacles and tasks that get in the way of managing patients. I do not think we have got as far as we would like to, but it’s a start.
Has the new contract delivered in terms of reducing bureaucracy for GPs?
GPs are suffering increased workload from all quarters and much of it does not relate to the contract. But GPs who look at their computer screens every day will notice the absence of those five indicators - now, there may just be one or two. For the QOF itself, we’ve removed 238 points. There were three DESs last year that were an annoyance to my practice and to others – they have now gone, and so have the QP indicators.
That is a positive step forward, but it has been overshadowed by the bigger issues around workforce, premises, and the huge amount of work that is not being resourced or recognised by policy-makers and the Government. We’ve certainly done the right thing for the contract, but we now need to move on to the bigger pressures that are affecting GPs.
Will you be the GPC chair that sees the break-up of the GP contract?
All patients should be given a core offer by every practice about the essential care they can expect. That care is consistent across the four nations - it’s embedded in the idea of equity and patients knowing what they can expect when they see their GP. It would be a real mistake for politicians or the public to be told that their access, experience or care should vary across the four nations.
I hope that the Government will recognise that it makes no sense to break up that core quality assurance to the public. If you did not have a national contract, you would be telling the population that there is no consistent assurance of what you can expect to receive in terms of GP care, and that would be unacceptable.
Is the contract supporting practices at the moment?
The problems are all to do with the way that it has been contaminated. The good will of GPs has been exploited over the years. We’ve been taken advantage of, with workload and activity piled on without recognition. That time has come to an end. The profession can’t put up with it. It’s not sustainable, and we’re seeing the whole system crack up because of it. But that is not a problem with the contract - it’s a problem with politicians and policy-makers not respecting and valuing what GPs provide.
Is there a way to fix that?
The two main GP bodies (GPC and RCGP) are trying their best to bring this to the public attention. The NHS and its future sustainability depends upon an infrastructure of general practice. That isn’t scaremongering - it’s a fact. If general practice implodes, the future of the NHS is in question. The bizarre thing is, to put this right wouldn’t cost a lot. General practice is currently funded at around 8% of the NHS budget - increasing that resource by a few percent could transform the NHS.
What will you do next year if there’s another below-inflation pay award?
It has become clear that the formula used by the Doctors and Dentists Review Body (DDRB) to assess expenses and the pay award is flawed, so now we are using our own health policy experts to look at how they assess GP workload and expenses. Politicians know a lot about hospital attendance, but we do not have tangible information about what GPs do and how much they’re doing. We’ll be getting some hard data on GP workload that should inform fair recognition of GP pay.
Practices in Somerset have been given the option to opt out of the QOF. What are your feelings on that?
We will wait with interest to see what happens. The GPs and area team there have said that practices will continue to provide the spectrum of care covered by QOF and the CQRS extractions will continue to occur, so patients in Somerset will be assured of the same care. QOF is still a reality in Somerset – GPs may not be signing up for it, but they’ll be delivering against it.
Do you think Jeremy Hunt cares?
Well, all politicians want to be elected. The best thing they can do is to improve the experience of patients when they interface with the health service - and for 90% of people, that’s when they contact their GPs. Around 340m patients visit GPs every year - that’s 60 times more than the 21m who walk through the doors of A&E. If I were a politician, I would want to improve that experience.
How can we stop good GPs leaving the NHS?
There are some immediate steps that need to happen. General practice needs to be valued. We need to stop the negative talk, and politicians in particular need to recognise the remarkable work that GPs do. We are the lifeblood of the NHS - without us it will collapse.
Secondly, we need to stop stoking up demand. If you have a workforce under strain, it becomes paralysed with exhaustion. We need to try to find ways of easing workload.
And thirdly, around investment - we can’t magic up GPs, but there are things that can be done including increasing investment in staffing and providing non recurrent funds for premises improvements. But looking to the medium to long-term, we need more GPs, more healthcare professionals supporting practices and bigger premises. That investment has to occur. Value GPs, and stop trying to pretend we can do twice as much when we’re struggling to do a day’s work as it is.
What do you think about Labour’s plans for a 48 hour-appointment target?
Do politicians never learn? The 48-hour target has been discredited. Practices that offer good care should offer good clinical care, and that may entail just waiting longer. I hope that the Labour party will alter that part of their policy, as it’s nothing more than a gimmick.
What have Labour and the Conservatives got lined up for us after the next general election?
It’s hard to say - especially with the coalition, because policies change according to the Secretary of State. There’s a lot in store that will occur regardless of who is in power, and we need to be ahead of it.
How can GPs help you to have more power and authority in the negotiations you’re going through?
Thank you for asking - you’ve been kind to me in my first seven months as GPC chair. GPs have enormous power at a local level to do the right thing. It is helpful if GPs stick together in terms of local level policy, and work with their LMCs to influence change.