GPs call for ‘radical’ solutions to ease winter pressures

GPs are urging the Government to put in place ‘radical’ solutions to ease pressure on general practice and urgent care, such as purchasing remote care from abroad.

The Government yesterday announced its plans to tackle increased pressures – that it linked to a record flu season and Covid backlogs – via additional funding for early discharge services and the setting up of modular hubs outside A&E departments.

It also said the CQC had agreed to reduce inspections in key areas, including general practice, and that an upcoming Primary Care Recovery Plan would outline how pharmacies could help to reduce pressures.

But Dr Dean Eggitt, chief executive officer of Doncaster LMC, told Pulse the announcement was ‘far too little far too late.’

He said: ‘It is yet another example of how our political leaders are out of touch with understanding the harm that is currently happening to patients.

‘It is no longer enough to temporarily postpone short-term targets to create immediate capacity. Suspension of chronic care is now contributing to the deterioration of the health of our nation.

‘Radical plans need to be put in place not only to buy capacity for urgent care here and now, but to bolster the health of those who are deteriorating and those whose chronic conditions are developing.

‘The NHS is full. It’s time that the Government bought virtual capacity from abroad. Failing to address this now will leave a legacy for a generation.’

Dr Manu Agrawal, chair of South Staffordshire LMC and clinical director at Cannock North PCN, said: ‘Even with extra winter access funds and other small streams of funding, the demand is unrelenting.

‘Along with the CQC reduction, which is welcome, the Government could have recycled all the IIF funds and underspend ARRS funds to help provide extra capacity within general practice, either at practice level or at scale.

‘Also, the suspension of QOF would be welcome. However, when CQC do return to inspections, it creates an issue around long-term conditions.’

NHS England announced in September that it would immediately retire or defer until the following year four investment and impact fund (IIF) indicators worth £37m and reallocate this funding to PCNs via a monthly support payment from October to March.

However, three of the indicators had already commenced in April so PCNs had already completed six months’ worth of work against them. 

More recently, ICBs have attempted to put in special measures to ease pressure on GPs but LMCs have told Pulse that they cannot go as far as they would like because of resistance from NHS England to suspending QOF.

And Dr Kieran Sharrock, BMA England GP committee acting chair, warned moving patients out of hospital, to be cared for by primary care services, will only exacerbate problems in the long run.

He said: ‘Practices are experiencing their most difficult winter yet, and need urgent support, resourcing and time to care.

‘There is no doubt that the need to discharge patients who are medically fit to leave hospital more quickly is causing a huge bottleneck, causing delays throughout the system.  

‘However, it is all well and good investing in services to speed up hospital discharge, but it is irresponsible to think that this won’t have a direct consequence for another part of our health system.

‘The Government has said that these patients will receive medical care from GPs, but moving pressures into primary care services, already at unprecedented levels of demand, will only exacerbate problems in the long run.

‘Current capacity within general practice is insufficient to meet the needs of patient and routine appointments, let alone take on more work with the backlog of pressures from elsewhere.’

However he welcomed the decision to reduce the burden of CQC inspections. The BMA wrote to the CQC in December to request that all routine and non-urgent CQC inspections of general practices in England be paused with immediate effect.

Dr Sharrock said: ‘We are glad, however, that the Government has finally listened to take a softer-touch, risk-based approach to CQC inspections, to ensure that vital staff time and capacity is focused on treating patients, rather than wasted on the bureaucracy of preparing for inspections.

‘While we’re keen to hear more about how the Government plans to reduce pressure on practices by enabling emergency care to refer to community pharmacists, the Primary Care Recovery Plan will need to go much further than this to stabilise general practice and deliver for patients and staff.’

Dr Michelle Drage, Londonwide LMCs chief executive officer, said: ‘Easing the regulatory burden on practices would provide some slight respite, but for general practice to be stabilised and recover from the current crisis it needs a serious and credible strategy to support partnerships, increase funding, retain staff and alleviate the bottlenecks and backlogs created elsewhere in the health and social care system.

‘Without such a commitment more of the workforce will decide their situation has no real prospect of improving and head for the door, further exacerbating the impact on patient care.’

This winter has seen GPs reporting dealing with overwhelming number of patient contacts, with the pressures hitting practices as early as November.

Deaths in England and Wales are 20% higher than the five-year average for this time of year, the Office for National Statistics has warned – a statistic that has prevailed for another week, according to data out today.

This comes as ambulance workers are again due to strike tomorrow (11 January) and two weeks from now (23 January).

Commenting on the ONS data, University of Cambridge emeritus professor of statistics Professor Sir David Spiegelhalter said: ‘Deaths registered in the last week of the year were 20% higher than expected, the same relative excess as the previous week which covered a period of very cold weather. 

‘Multiple factors will be contributing to this: early flu, Covid, the impact of disrupted care in the pandemic, and the acute crisis in the NHS.  Research has shown that delays in admission are linked to increased mortality rates, and it is plausible that this is leading to hundreds of the excess deaths.’

He went on to warn that this was ‘not just a winter issue’, with ‘high excess non-Covid deaths since June’ having coincided with ‘disruption in ambulance response times and A&E waiting times’. Excluding Covid deaths, there has been an average of around 450 excess deaths each week since June, said Professor Spiegelhalter.

‘The continuing pattern of excess deaths deserves close scrutiny,’ he concluded.

Number 10, the Department of Health and Social Care and NHS England all declined to comment further.