'Government has turned a cruel blind eye to patients'
GPC chair Dr Chaand Nagpaul gives his final speech before taking on role as chair of the BMA
In the past year the government has turned a cruel blind eye to the needs of patients, with continued savage cuts and austerity, and ignoring pleas from NHS England Chief Executive Simon Stevens, the Parliamentary health select committee, and all authoritative opinion that the NHS desperately needs more resources.
Despite facing this financial brick wall, GPC across all four nations has worked hard to support GPs. In England, we secured NHS England’s acceptance of GPC’s urgent prescription for general practice, paving the way for significant contract improvements for 2017/18, paying for rises in indemnity fees, full reimbursement of ludicrous CQC charges, and ending onerous bureaucratic workload by abolishing the unplanned admission enhanced service, and with the full £157m added to core GP budgets. We’ve ended the financial risk to practices of £66,000 per GP annually for long-term sickness, by negotiating reimbursement as a right. In Wales there have been similar improvements, and Scotland is negotiating a new contract to reduce practice burdens. Sadly GPs in Northern Ireland have faced a lack of functioning government, hung out to dry with an inability to negotiate and they know that GPs across the UK are completely behind them in their actions to protect themselves and their patients.
Despite these annual contract improvements, general practice remains on the brink of collapse, since fundamentally demand totally outstrips our impoverished capacity. We’re seeing 50m extra patients annually in general practice compared to five years ago, with increasing care moving into the community and a growing older population - yet latest figures show that today we have fewer GPs per head than then. This mismatch has resulted in unmanageable workload with over eight in 10 GPs saying they can’t provide safe care, which is an indictment of government policy that promotes safety in the NHS.
Given we can’t magic up GPs, GPC’s efforts have been to manage demand and workload. We know that one in four GP appointments are avoidable, that’s for patients who could have self-cared, or seen another professional, or appointments taken up for inappropriate or bureaucratic purposes.
The priority must therefore be to liberate these appointments - that would in effect increase GP capacity by 25%, far greater than the political mirage of 5000 more GPs - remembering that every wasted GP appointment is an appointment denied to a sick patient. That’s why GPC has secured hospital contract changes in England that include no longer requiring GPs to re-refer a patient after a missed clinic appointment, allowing hospital doctors to directly refer a patient to another specialist for a related problem, and deal with patient queries directly rather than asking for another GP letter. This will not only free up 15 million GP appointments annually, it saves hospital work too, by ending the ludicrous bureaucracy of shifting paperwork back and forth between GPs and hospitals.
Not wasting GP appointments is also key to addressing hospital pressures, since just a 6% reduction in GP appointment capacity would double the number of patients attending A&E if they went there instead – highlighting why under-resourcing general practice is so damaging for the NHS
GPC has supported practices to take control of workload through our Quality First web tools to manage demand, empower patients, and use new technologies - with 52,000 unique hits in the past 12 months. GPC has also supported multi-professional working to enable patients to see other healthcare staff such as practice pharmacists to directly relieve pressure on GPs
In England, the government last year introduced its GP Forward View investment programme –but this is operating with a wholly inadequate NHS pot, and as the recent LMC conference stated is insufficient to sustain general practice, and why GPC is demanding fit for purpose resources for GPs to work within safe workload limits.
The individual GP practice unit is frighteningly vulnerable, with one in 10 practices surveyed saying they’re not financially sustainable. A record number of practices closed last year, - not surprising with 1 in 3 practices unable to fill GP vacancies. That’s why GPC is pushing for tailored resilience support to be rapidly deployed to practices who are at their most vulnerable, since each practice that collapses will have a domino effect on the rest of the local healthcare system
GPC believes that key to achieving sustainability is for practices to work together to create collaborative resilience, as we did in the 1990s when we formed GP out of hours cooperatives to cope with our then gruelling 24hr contractual responsibility. GPC has produced resources and held a major conference this year on working at scale – we’re now seeing GP led models springing up across the country – from super-partnerships, to federations and with emerging evidence of this supporting the viability of individual practices, reducing GP workload, and managing demand.
The past year has graphically demonstrated the damaging impact of outsourcing NHS services to the private sector, with Capita completely mishandling the delivery of primary care support services in England, showing you simply can’t run the health service using cost-cutting commercial tactics. This has adversely affected quality and safety such a GPs trying to care for patients without medical records, and yet this has shamefully escaped the regulatory vilification that practices would receive from CQC inspections for a fraction of such shortcomings.
The GP workforce is particularly diverse with some 40% of GPs not covered by the national contract, with increasing numbers wanting to work as freelance locums, salaried, and portfolio roles. Our recent GP survey showed that the shrinking pool of partners are reporting greatest levels of unmanageable workload compared to any other category of GP. It is vital we support each other as one GP profession, since if the partnership model collapses it will sink the entire profession in the process, with the risk that all GPs will in the future be at the mercy of working for large commercial providers, who are likely to have values and an ethos at odds to everything we stand for.
GPC has worked hard to make the crisis affecting general practice visible. We’ve come a long way in four years, in which now policy makers and even the GP Forward View explicitly states we’ve been starved of resources, with too few GPs and excessive workload. Where all major political parties placed general practice central to their manifestos. And when primetime TV news and the national press are regularly running stories on the plight of practices struggling to cope with unmanageable demands.
Now is the time for us to stake our claim. The general election result of a minority government serves as a clear mandate to abandon the callous disregard of patients through austerity and cuts. A mandate to respect the intelligence of the electorate and not hoodwink them with populist propaganda of being able to offer a consumerist service on Sundays when the NHS can’t survive the winter without support from the Red Cross. A mandate to invest properly in the NHS and plug the £10b funding gap that separates us from European averages, and a mandate to finally give general practice the resources for GPs to provide safe quality care to patients and restore our professionalism.
RB, this is my last speech as GPC chair after 4 years’ service. I’d like to thank my executive team Richard Vautrey, Mark Sanford-Wood and Gavin Ralston for their unswerving support, the 3 devolved nation GPC chairs Charlotte Jones, Tom Black and Alan McDevitt for representing their nations so assiduously, and to all GPC members for their valued contribution. Representing the lifeblood of the NHS that is general practice has been an absolute honour which I am committed to continuing with vigour in my new wider remit at the BMA.