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NHS England ‘can and will do more’ to explain GP practices are open to public

ICSs must better understand primary care, says Dr Nikki Kanani

NHS England ‘can and will do more’ to explain to the public that GP practices are open, primary care medical director Dr Nikki Kanani has said.

She added that practices need to ‘retain the public’s confidence’ that they can see someone when they need to.

Dr Kanani also said GPs could expect an update letter and details of further ‘support’ in the coming days, in light of this weekend’s announcement of a new national lockdown.

It comes as the Medical Protection Society (MPS) revealed that one in three doctors have suffered verbal or physical abuse from patients or their relatives during the Covid-19 pandemic.

Dr Kanani made the comments today at the keynote session of this year’s virtual Pulse LIVE conference, which will run until December.

She told delegates: ‘We need to get the balance right between the innovation we’ve rightly had to offer out of necessity and the ability to retain the public’s confidence and relationship with general practice – part of which is through being able to see a member of their practice team where it’s safe and clinically appropriate to do so.’

Responding to a question on whether NHS England could help put across the message that general practice is open, as well as the reasons for moving away from face-to-face contact, Dr Kanani said ‘we can do more and I know we will do more’.

She added: ‘I will keep saying it and we will keep amplifying that. General practice was not closed, general practice won’t close, general practice is always open.’

However, Dr Kanani added that some practices have had ‘difficulty’ in describing ‘what access to their practice now looks like’.

She told delegates: ‘I’ve had patients send through their experiences which we’ve followed up. This is not by and large practices trying to do anything wrong. They are desperately trying in a really difficult time to offer good care and that is seen again and again. 

‘What we need to be doing is supporting practices to make sure that offer feels tangible to the public.’

Meanwhile, Dr Kanani added that patients have ‘broadly’ been ‘incredibly grateful for the ability to access care despite a national pandemic’, but that GP health and wellbeing ‘is a priority’.

Practices have been facing increasing abuse from patients lashing out at them because they believed practices were closed and blaming them for changes to national guidance.

It comes as GPs called for ‘more support’ from NHS England after a practice was attacked with anti-GP graffiti last weekend – an incident they linked to GP bashing in the mainstream media.

NHS England’s primary care medical director last week joined the outpouring of support for the GP practice which was vandalised.

In September, NHS England landed itself in hot water with a ‘reminder’ to practices to offer face-to-face consultations despite the ongoing pandemic and its own ‘total triage’ advice.

An open letter from grassroots GPs highlighting the profession’s concern about ‘inaccurate and harmful’ media messages about access to care last month received over 400 signatures.

And Dr Kanani last week told GPs and their teams they are ‘valued and appreciated’, as new figures revealed a sharp increase in the number of GP consultations last month, a majority of which were face to face.


Alan Woodall 2 November, 2020 1:55 pm

The key words, which NHS England need to communicate out clearly are
NEED (not want), SAFE (balancing benefit and risk to all) and CLINICALLY APPROPRIATE (there is no need to see everything). We have lives and families too who we want to protect from Covid, and we are already at higher risk than the average member of the public,

And we decide the above, not patients. Hurling abuse at staff, or threatening staff with time consuming complaints you don’t get what you WANT (as many know this is to be avoided solely for the work to staff involved) should not sway the clinical decision. These should be thrown out.

Years of feeding the population the consumerist ‘I want it now’ model of health has come back to bite NHS England squarely where it hurts, Time to grow a pair NHSE.

Reply moderated
Gareth Richards 2 November, 2020 2:30 pm

What I want is NHSE saying general Practice is, and has been, working hard, despite risks to their own and their families lives through Covid-19 and patients should trust our professionalism to deliver the care that they need at this time; either through telephone, face to face or e-consults.
About as likely as a fish riding a bike!

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Bob Hodges 2 November, 2020 2:58 pm

Spot on Alan

Somes it feels like we go for days without the ‘Need’ and ‘demand’ sets overlapping at all.

Stick THAT on a Venn diagram.

I’m complaints lead fora very large practice. I can’t remember the last time I needed to to use the the words ‘sorry’ or ‘apology’ in a response. Most complaints are born of misplaced expectations and the falalcy that ‘hurty feelings’ constitute harm to them or dereliction of contractual obligation on our part.

Actually, the few complaints where the patient has come to harm or where we could/should have done better (and can learn something) are much quicker to deal with and more like to be resolved to everyone’s satisfaction.

Patrufini Duffy 2 November, 2020 2:59 pm

Definitely Alan.

Fresh examples from the covid era real world NK. To refresh your memory. Not the “modelling, advisory, board meeting, target, contract this/contract threat, fairy tale, patient comes first, world-leading, bullying, warped, derogatory” world some people are living in:

1. I want an emergency appointment. I want a blood test, I just haven’t had one for a while.
2. I’d like another smear test again. Because I get one every year in France.
3. Can you put antibiotics on repeat, it’s an inconvenience calling you.
4. I’d like to see a dermatologist for my mole. Yes, it’s the same, all my life. I need my varicose veins checked too.
5. I need my pill now. It’s urgent. I need it before the weekend, I’m at the pharmacy. I’m waiting, you need to send it now, or I’ll complain.
6. I want a swab me for chlamydia? I just want a check up.
7. I need 3 private referral letters. Yes for podiatry, a psychologist and yes, another mole check. Can you email them to me today? Why not?!
8. I saw a nutritionist. And they want me to have blood tests. I want my copper and blood group checked too.
9. I want to start antidepressants, I just split up with my boyfriend. I need sleeping pills too.
10. Can you send my repeats to Liverpool from London. I’m ‘self isolating’ here for 4 months. I also need a referral. But, I want it here in Liverpool.

This is the real drivel. This is not health. It is petty, trivial, regurgitations. The real stories of shameless GP abuse. And you lead an organisation that promotes it. NHSE has hysterics with irrelevant data, capturing meaningless codes and made up presumptions. This is not care, it is careless, inert, and empty General Practice. That harms the system, clogs the pathways and makes others suffer. Devoid of meaning or desire the workforce is flat. The coal face of public consumerism you forgot. And USA is keen, on this cash and carry shop. But you will move into your next advisory role, with Stokes-Lampard, Hunt, et al. No NK we don’t need to ‘do more’. It is a worldwide joke. Some countries have a checklist of “what to get” when they land here. UK medicine under it’s ‘leaders’ has been turned into a place where the patient rules, and your intelligent workforce have decided they cannot be bothered with the cyclical buzz words and manipulations. A successful NHS with no radar but to privatisation, just contracts given to secret friends in the NHSE lobbying group whilst genuine workers get slayed and massacred. We could all do with a new PDP. And DEN. And reflect on safe, effective care and leadership domains.

Reply moderated
Chris GP 2 November, 2020 3:02 pm

Just to “keep amplifying” general practice is open is not enough – in fact from the lips of Nikki along with the sympathetic eye rolling (what is THAT all about???) – it is probably harmful. It has to come with a firm note that 1) We always have been open 2) GP’s are doing what they can to balance the risk to patients and staff during the pandemic (in terms of the use of limited resource and the risk of infection) 3) It is no more acceptable to verbally abuse and shout at staff than it is for staff to shout at patients.
We also need absolute concrete reassurance that we are not going to be hung out to dry as usual when this all goes t*ts up. I am not holding my breath.

Simon Gilbert 2 November, 2020 5:55 pm

9.8% of my patients each week know we are open as they get a consult with us.
The ‘true’ number for our demand would be even higher if our telephone list was open ended.

Stuart Buchanan 2 November, 2020 6:06 pm

Patrufini and Alan are spot on. NK still seems to get it wrong even when she apologises…. she is just so out of touch or she wouldn’t make these dumb statements to begin with. I think most G~Ps are disillusioned with NHSE and aren’t impressed. The issue is, is that they are stuck in a monopoly where you can’t escape the incompetence. Its like been stuck on a small desert island with your abuser…….no wonder people emigrate

Vinci Ho 2 November, 2020 7:13 pm

The more you tried to ‘repair’ the damages done , the more calamitous it looked :
(1)What is the interpretation in layman’s terms for ‘can and will do more’ ? It means NHS England had done f**k all during the first wave to inform the public properly that GP surgeries were open . Please do not tell me that it was the responsibility of practices to do so instead , especially under ‘command and control’ against the backdrop of Coronavirus Act 2020 ,
(2) However , if you still think you had done enough to inform the public , isn’t it logical NHS England must then issue an official statement condemning any fake news and rumours distorting the truth and misleading the public ?
(3) The reason why your previous letter warning GPs about face to face consultation had not only seriously hurt the feelings of frontline GP colleagues, but also out of injustice , convicted them of breaching professional code turning patients away .
Hate to say this :
I suggest you to keep your silence from now on if you are not prepared to step down .

Reply moderated
Patrufini Duffy 2 November, 2020 8:24 pm

As a ‘GP’ NK must be used to getting a blasting. But, paradoxically, she is on the team dishing it out. That’s plain weird or sick. She is not a GP Partner, which is the biggest elephant in the room. Her side kick ED WALLER seems to have evaded Pulse’s intelligent eyes. Another puppeteer akin to Dominic Cummings, in the shadows, playing contract games and threats and signing off instructive letters from the sterility of home. Can we have a quotation from him, or spotlight on his views? Perhaps he’s working on next year’s PCN DES shirade and contractual “obligations” and countless loopholes, and tricks without treats but plenty of traps. Can we ask him to tell GPs who manned dangerous “hot clinics” in round 1 that they weren’t seeing enough F-F? How many did he see? Contractual breech has become some sort of heartless inert threat, like I’ll take your passport away from you. Or I’ll sink your migrant boat. As you’re getting paid by the taxpayer, we’d like to see your salaries published on the NHS website, you to upload your feedback into your appraisal and complaints you’ve incurred also and how you’re running your own practice, as you clearly know what is the “landscape” from the sky. I like reading the Pulse comments, they show people with heart, intuition, awareness, intelligence and truth. Things which NHSE have a strategy to extinguish.

John Graham Munro 2 November, 2020 9:15 pm


Turn out The lights 3 November, 2020 7:43 am

NHSE and your puppets, the good will mine in GP land is exhausted watch the rush for the door will speed up despite your underhand and decietful briefing to the press and your crocodile tears platitudes.We have had enough you could have a 2004 moment again and it will not stop the rush towards the door.Hope you have a plan to replace the foot soldiers you are shooting in the back.Your going to need one very soon.

David Church 3 November, 2020 11:03 am

No, No, please don;t let Dr Kanani or NHSE do any of this.
It is probably better if they not say anything to the public at all.
Get a hard-working GP or LMC Secretary to do it instead.
Public would probably put more store in what their own GP says locally.
Can we put it on the ITV network, or HTV, or whatever it’s called in each area?

Michael Mullineux 3 November, 2020 12:41 pm

Obsequious oleaginous egocentric flunkies

terry sullivan 5 November, 2020 11:24 am

between his ears

Reply moderated
Kevlar Cardie 6 November, 2020 2:39 pm

If the post of Primary Care Medical Director was abolished (not a specific individual removed from post: this isn’t an ad hominem attack) would it actually cause any harm ?

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tara watson 6 November, 2020 5:18 pm

Difficulty getting through on the telephones is one of the reasons patients feel surgeries are closed. I often have to phone practices in different parts of England without use of a bypass number. First you have to “listening” to the endless Covid messages and instructions, then choose alternative options, then are told there is a long wait ahead. Can take me 20 minutes to get through. I also have to be quite assertive to get what is needed, for patients, even though i introduce myself as a doctor.
I am fairly tenacious and not ill, but ill people must feel like giving up at times.
If our phone systems are up-to-scratch and size of reception team big enough. That is psycholocallly very helpful. Accompanied by polite help & intelligent signposting at this stage, patients will feel much more that surgery is “open”.
Perhaps we should all try phoning our own practices once a month with a disquised voice.


Finola ONeill 7 November, 2020 9:02 am

The poisonous brief was from NHS England to the press. What I’m interested in is why? Seems a bit too much like Johnson et al’s blame games. Blame the GPs, then maybe divert the attention on those emails we got about frailty scores and blanket approaches to treatment plans for the elderly and care home patients. NHS England has had their day. An arm of the govt in my opinion and no more use to clinical care. Time for funding and power/control to come back to hospitals and surgeries. End of CCGs, end of NHS England. Time wasting, money draining, management heavy, chocolate teapot. We need to take back control. That will be my next project. Just think how much money would be saved without all those management structures. Let’s see a breakdown on that funding.