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Mythbusting the ‘rescue plan’

Jaimie Kaffash scrutinises some of the more dubious statements in NHS England’s plan to improve access

It is true that patients’ ability to access primary care is often not as good as it should be. Some patients are experiencing unacceptably poor access to general practice, including an inability to contact practices
Paragraph 4, NHSE plan

As with any other business, profession or industry, there are inevitably variations in quality between practices. 

But, considering this statement is the basis for NHS England’s whole strategy, one would expect compelling evidence to support such a statement. The evidence provided by NHSE? ‘As witnessed by their stories and those reported in the media.’

In the previous paragraph, actual hard evidence is quoted – the GP Patient Survey 2021 of 850,000 patients – which ‘showed increases in: overall patient satisfaction with general practice; patient satisfaction in being able to make an appointment; and patient satisfaction with the appointment times offered’.

A series of measures are already being put in place to address [problems with access], including through the 2019 five-year GP contract, boosted by the Government’s manifesto commitments to improve general practice capacity by increasing the size of the primary care workforce and delivering 50 million more appointments” 
Paragraph 6

In the same paragraph, NHS England acknowledges ‘the access challenge mirrors overall workforce capacity including the number of GPs’. But the use of ‘boosted’ is jarring: so far, these are just ‘commitments’ that haven’t yielded anything for GPs. Past performance suggests they may never be fulfilled. 

Practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary” 
Paragraph 7

This depends on the definition of ‘good clinical reasons’. GPs will point out this is exactly what is happening. There is a lack of capacity in general practice, and GPs prioritise the demand based on just such reasons – like every other part of the NHS. But by making patients think they have the ‘right’ to see GPs face to face, NHSE is removing GPs’ ability to do this.

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” 
Paragraph 8

This seems to be in direct contradiction to the ‘digital-first’ strategy laid out in 2019, which said:  ‘The development of digital general practice now offers the possibility that has never before existed – to expand GP capacity for patients in an area even when the GP sessions are provided at some distance.’ But by NHSE’s latest definition, the ‘digital first’ strategy is ‘likely to be contrary to good clinical practice’.

The £250m fund could be used to make ‘full use of the digital locum pool framework
Paragraph 14

Commissioners have been given until mid-December to set up local digital locum pools, but practices must show progress by then to be eligible for funding. Dr Ben Molyneux, BMA sessional GPs committee chair, adds: ‘It’s not as if there is a large group of locums on standby, waiting for a call from their local practice to help out.’

The latest comparable data showed that there were now over 1,200 more full-time equivalent (FTE) GPs than two years before” 
Paragraph 17

Technically true, but this is sleight of hand as they are including doctors in training. Including only fully trained GPs brings the increase to a more modest 101

Integrated Care Systems have been asked to look at ‘the 20% of practices locally with the lowest level of face-to-face GP appointments”
Paragraph 42  

The focus on ‘GP appointments’ seems to contradict primary care director Dr Nikki Kanani’s words at the RCGP Conference the day after publication: ‘This is not just about a face to face with a GP, we have many other colleagues better able to offer care to our patients than we are, and that must be recognised and celebrated.’

Also, even the most basic maths tells you that, however many improvements are put in place, one in five practices will always be in the ‘lowest’ 20%.

Where practices do not engage with support and are in breach of their contractual obligation to meet the reasonable needs of their registered patients, appropriate contractual action will need to be undertaken by CCGs/ICS” 
Paragraph 45  

This looks scary, but actually isn’t saying much. Commissioners would need to show practices are going against patients’ ‘reasonable needs’ to prove a breach of contract. Refusing unnecessary face-to-face appointments would not count.

Click here to read all Pulse’s coverage of NHS England’s plan