Thérèse Coffey’s plan for the NHS turned out to be a damp squib. But even the lack of detail won’t prevent it becoming a headache for GPs. Rachel Carter reports
With a new Prime Minister comes a new health secretary, and Thérèse Coffey has been named as the person for the job. The fifth incumbent in just four years, she inherits the brief at a time when arguably all parts of the NHS are in severe crisis.
Dr Coffey kicked off her tenure with a questionable appraisal of primary care, heralding ‘doctors, dentists, chiropractors’. But her first real intervention in the post came in the form of the document Our plan for patients. Its release was preceded by headlines around GPs having to see patients within two weeks, and threats of league tables.
However, like most of the initiatives from her predecessors, the plan when it came was devoid of detail, relying on soundbites and little else. Unfortunately for GPs, that doesn’t mean it won’t make their working lives even harder. Here, we analyse her pledges.
‘We will set the expectation that everyone who needs an appointment with their practice within two weeks can get one… We will inform patients by publishing data on how many appointments each GP practice delivers, and the length of waits for appointments, to enable patient choice’
Dr Coffey’s plan instructs GPs to offer an appointment to ‘everyone who needs one’ within two weeks. First, this ignores statistics showing this is largely happening already: the latest NHS Digital figures show 85% of appointments in July were within two weeks of booking. And second, there is nothing in the plan to say what will happen to practices who don’t meet this deadline.
In an interview on LBC radio, Dr Coffey implied the penalty for practices will be patients jumping ship – meaning the practice would lose money. As shadow health secretary Wes Streeting said, it seems Dr Coffey’s message to patients is ‘get on your bike and find a new GP’.
More significantly for GPs, a patient hoping to make such a move will be able to check practice-level data on appointments, which the Government intends to publish from November. This in itself is not a new pledge; former health secretary Sajid Javid made a similar commitment last autumn in his own, short-lived access plan.
Coffey’s pledge will cause problems for practices, who will face being named and shamed. Surrey GP Dr Dave Triska says publishing the data will be ‘punishing the practices that are struggling the most,’ which is ‘not a helpful action’.
‘All that will happen is practices will just block their appointments from two weeks forward so all appointments will be booked within two weeks, it’s an easy one to jump through the hoop for,’ he adds.
And in reality, the information is unlikely to be of much help to patients. Those who do attempt to move
practice after viewing the appointments data could face similar waiting times at neighbouring practices, because this is a wider structural issue. Plus, taking on new patients will only serve to increase the pressures a practice faces, given the current workload and workforce crises.
Regardless of the viability of the health secretary’s plans, the damage will already have been done, with patient expectations raised. On the day of Dr Coffey’s announcement, GPs reported that patients were already calling and expecting an appointment within two weeks.
Nottingham GP Dr Irfan Malik tells Pulse: ‘It has already caused tension with people ringing up reception. It hit the all media and you know it was quite clear what the message was from the Government, so already the expectation has changed on the frontline from patients – they want appointments within two weeks.’
This can be expected to happen ‘all across the country’, Dr Malik adds.
Dr Coffey also pledged to make an additional 31,000 telephone lines available for GP practices from January 2023. But as most practice staff will be quick to point out, extra lines are no use if there are insufficient reception staff to answer them, and insufficient clinical staff to provide additional appointments.
‘We will change elements of the NHS Pension Scheme to help retain doctors, nurses and other senior NHS staff, to increase capacity, correcting pension rules regarding inflation’
The health secretary has appeared to heed warnings that the profession is losing too many experienced GPs due to pension rules – and made a commitment in her plan to remove inflation-related pension tax.
One issue relates to tax-free annual allowance (AA) charges, which apply when an individual’s pension grows by more than the maximum allowed amount of tax-free growth in one year. Put simply, high inflation affects the doctor’s pensions tax, but will be unlikely to inflate their actual pension. As the BMA puts it, this means doctors are potentially being charged on ‘a benefit they will never actually receive’.
The Department of Health and Social Care said it will amend the revaluation date in the NHS Pension Scheme to reduce the ‘risk that NHS staff face annual allowance tax charges as a result of high inflation’, which will benefit senior clinicians.
They would also include extending retirement flexibilities to ‘allow retired and partially retired staff to continue to return to work or increase their working commitments’ without having their pension benefits reduced or suspended.
However, the BMA said these were ‘sticking plaster’ solutions.
Dr Vishal Sharma, BMA pensions committee chair, said moving the revaluation date will ‘partially mitigate the problem’, but what was needed was an urgent amendment to legislation ‘to prevent doctors being unfairly taxed on pension benefits that they will never receive’.
‘We can expect to increase the number of appointments for patients by over one million by freeing up funding rules to widen the types of staff that work in general practice’
The press release that came ahead of the full plan promised that primary care networks would have the ability to recruit advanced nurse practitioners under the additional rules reimbursement scheme (ARRS) – something that many GPs had been asking for.
However, the plan itself makes no mention of ANPs. Instead, it only sets out proposals around ‘GP assistants and advanced practitioners’.
When quizzed by Pulse, the DHSC said two new roles – GP assistants and digital transformation leads – will be added to the additional roles reimbursement scheme (ARRS) from October 2022. How useful this will be is another matter – a recent study showed that such healthcare professionals haven’t reduced GP workload.
The plan also sets out an intention to expand the number of mental health practitioners (MHPs) in primary care. Yet this seemed to echo updates made earlier this year to the 2022/23 Network DES, which ensured PCNs would be able to employ twice as many adult mental health practitioners, with the approval of their provider.
The DHSC told Pulse that advanced nurse practitioners would be added to the scheme at a later date.
‘We will expand the range of services from community pharmacies, increasing patient convenience and freeing GP time for more complex needs of patients’
Trailing the plan, the Department of Health and Social Care (DHSC) said pharmacies will ‘help ease pressures on GPs and free up time for appointments by managing and supplying more medicines such as contraception without a GP prescription’.
It said this ‘could free up to two million general practice appointments a year’.
However, details on this ‘enhanced role’ for pharmacists remained scant in the plan itself, which simply states: ‘Pharmacists will be able to manage and supply more medicines, without a prescription from a GP.
‘We will look to go further on enabling pharmacists with more prescribing powers and making more simple diagnostic tests available in community pharmacy.’
However, updates to the community pharmacy contract, published alongside the plan, do provide some substance.
They reveal that ‘tier 1 of a pharmacy contraception service’ will be introduced from 11 January 2023. The new service will allow high street pharmacists to ‘provide ongoing management, via a Patient Group Direction, of routine oral contraception that was initiated in general practice or a sexual health clinic’. They will be paid a fee per consultation of £18, as well as an initial ‘set-up fee’ of £900.
‘We will expect the local NHS (integrated care boards) to intervene where services need to be improved’
In keeping with the plan as a whole, detail is lacking on how and when Integrated Care Boards (ICBs) might be expected to ‘intervene’. But ICBs by their nature are not as local as CCGs, leaving GPs concerned actions will be more punitive.
Tower Hamlets GP Dr Selvaseelan Selvarajah say: ‘ICBs are still being set up and we don’t have an idea of what exactly is going to be measured, so I can’t see how ICBs intervening is going to help. CCGs would certainly have known what practices were struggling anyway, so I’m not sure what new this is going to add.’
He adds that a lack of local knowledge in ICBs could ‘absolutely’ be a problem: ‘I don’t think ICBs have the capacity to be performance managing general practice at the moment, even CCGs struggled and now you have mergers of CCGs forming much larger bodies, which are still being formed, not all roles – certainly locally – have been recruited to so I’m not sure how this idea will work.’
Tower Hamlets LMC chair Dr Jackie Applebee says the plan fails to understand general practice: ‘Most of us are running digital access alongside telephone or walk-in appointments, and in general, wait times to see a GP have gone down. In my practice, we speak to most people within 24-48 hours of them getting in touch.
‘The pandemic has transformed access and Thérèse Coffey seems to be behind the times on this.’