Today, NHS England announced winter funding of £250m for general practice to ‘increase the proportion of appointments delivered face to face’. The BMA described the package as ‘flawed’, with patient care to suffer as a result. Here’s what others felt:
BMA GP committee chair Dr Richard Vautrey – ‘After weeks of promising an ‘emergency package’ to rescue general practice, we’re hugely dismayed that whilst additional funding has been promised, the package as a whole offers very little and shows a Government completely out of touch with the scale of the crisis on the ground.
‘GPs and their teams will now be facing the worst winter for decades, and as a result, patients’ care will suffer. Appointments will be harder to book, waiting times will get longer, more of the profession could leave and GPs will struggle to cope.
‘It is also disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments; we need a more intelligent conversation about the variety of appointments and care that are available to patients to meet their needs.
‘While in-person consultations are a key feature of general practice and absolutely necessary for some patients and certain conditions, the pandemic has proven that in many other cases phone or video appointments are entirely appropriate and appreciated by patients, and a crude focus on percentages or targets is completely unhelpful.
‘Throughout our discussions with ministers and NHS England in recent weeks, the BMA has been clear that without a concerted effort to reduce bureaucracy, admin and red tape in practices, patient access and care was at risk.
‘Unfortunately, today’s offer merely tinkers around the edges, and will not reduce the unnecessary burden practices carry and and therefore free up any more time for doctors to see more patients. We need an end to target-driven, payment-by-results, care and allow practices to look after patients in a way that is flexible and right for the person in front of them and the Government have missed an opportunity to tackle this.’
RCGP chair Professor Martin Marshall, speaking at today’s RCGP conference in Liverpool – ‘A so-called support package for general practice in England, announced this morning, is most definitely not the answer to the challenges that we face in providing high-quality care for our patients.
‘Calling today’s announcement a missed opportunity would be the understatement of the century.
‘Addressing workload is our top priority as a college, and also why I’m so disappointed with today’s government announcement in England.’
Health secretary Sajid Javid – ‘I am determined to ensure patients can see their GP in the way they want, no matter where they live. I also want to thank GPs and their teams for their enormous efforts in the most challenging times in living memory.
‘Our new plan provides general practice teams with investment and targeted support. This will tackle underperformance, taking pressure off staff so they can spend more time with patients and increase the number of face-to-face appointments.
‘Alongside this we are setting out more measures to tackle abuse and harassment so staff at GP surgeries who work so tirelessly to care for patients can do so without having to fear for their safety.’
NHS England chief executive Amanda Pritchard – ‘Improving access to high quality general practice is essential for our patients and for the rest of the NHS too.
‘It is a personal priority and today NHS England is taking both urgent and longer term action to back GPs and their teams with additional investment and support.’
Dr Angela Bennett, a GP in Cambridge – ‘£10k per practice won’t buy much, and also there aren’t the extra staff to do extra work. I am a portfolio GP, six sessions in practice which is at least 40 hours often more, and two sessions doing GP education. I usually work on my day off and weekends and some days of annual leave. I’ve been known to take annual leave just to catch up on paperwork. The red tape is increasing.
‘At our surgery, we already offer F2F to all who want/need it, following telephone triage to work out what’s best. Targets for F2F would take away our and our patients ability to decide that together. We need long-term extra cash to employ more admin staff. £250m time-limited which may not actually be extra money is quite frankly an insult. Staff and doctors are burning out here. As I write, I’m at work with a horrible migraine and feel sick. Today’s news has made this worse. I’m duty doc this afternoon. If I go off sick with the stress-related migraine, who will call the 15 patients I have booked in? Who will process 100 letters, check 100 results and sign 50 repeat prescriptions?’
Dr Prakash Kachhala, a GP in Nottingham – ‘The daily front page headlines are leading to many patients, whether they have tried to access care or not, to believe the hype and “fake news” that GPs aren’t seeing patients. They are getting angrier and angrier. It’s receptionists, the front line, that end up victims of shouting and aggression. They can only take so much.
‘Often the patient has no care or desire to know who the person is on the other side of the call. Even a brief question: “and what is the issue you need to speak to a doctor about?” is now met with a barrage of abuse, as patients feel they have a right to demand to see a GP at a time of their choosing. There is no understanding of how busy we are.’
Dr Richard Cook, a GP in West Sussex – ‘Underwhelmed? I reckon it’s about £4/patient – hardly groundbreaking. There are no locums as they well know. Publicity stunt and little else – their overall agenda with regards to the NHS and GPs in particular should be extremely concerning for the public at large.’
Dr Irfan Malik, a GP in Nottingham – ‘The media headlines today, based on the Government primary care access plans are quite threatening and intimidating to GPs. General practice has collapsed onto its knees, terms like ‘naming & shaming’ and ‘hit squads’ are adding fuel to the raging fire. The hard-line Government approach will lead to more GPs leaving and worsening the crisis.’
Dr Thomas Round, a GP in London – ‘Another missed opportunity. Where is the extra GP or AHP capacity going to come from? Unfortunately, the political discourse is focusing on face-to-face appointments than the fundamental issue of lack of capacity and burnt-out staff.’
Dr Siema Iqbal, a GP in Manchester – ‘It appears that the Government is detached from what is actually happening on the frontline and blind to the anti-GP rhetoric from some of the media. Although caveated funding is being made available and an increase in GP numbers is being flouted by the Government, it overlooks the fact that this is not enough to meet the demand and certainly there are not enough GPs to see patients face-to-face at their preference.
‘As much as we would like to see every patient face-to-face, who will take responsibility for waiting times which could be up to three months, whereas at the moment we as clinicians know best who needs to be seen face-to-face based on clinical need preventing the total collapse of a service that is already struggling?’
Dr Shan Hussain, a GP in Nottingham – ‘I think it totally misses the point. There aren’t enough staff available and the few of us left are overwhelmed. To publicly name and shame practices that simply can’t find qualified workers is quite outrageous. Given the nature of the recent attacks against the profession, why would anybody want to go into general practice right now? What are they doing to make the job more attractive?’
Dr Heather Ryan, a GP in Merseyside – ‘Today’s announcement is hugely disappointing. The emphasis on ‘managing underperformance’ is hugely dispiriting when the vast majority of GPs are working incredibly hard and doing our best. The access problems that some patients are experiencing aren’t because GPs are off on the golf course, ready to be tempted back with funding for locum shifts. These access issues exist because primary care has been underfunded and under-resourced for years.’
Dr Andy Hilton, GP and chief executive of Primary Care Sheffield (Sheffield’s GP Federation) – ‘Extra investment in general practice is welcome but needs to be recurrent and part of a more considered strategy. The package announced today ignores the scale of the workforce crisis – existing staff are already working harder then ever with little or no capacity to do more and it is getting more difficult to recruit into new roles. We need a proper long-term workforce strategy and a broader approach to integrated 24/7 primary care access that retains some of the benefits we have seen from new delivery models developed through the pandemic.’
Dr Helen Miles, a GP in Oxfordshire – ‘After a busy morning, I feel this letter illustrates a growing disconnect and lack of understanding. There is a lack of listening to and trust of our profession. Any support that is offered is of the knee-jerk, sticking plaster variety and comes with additional asks and a failure to understand the destabilising consequences of many of the measures suggested.’
Dr Nisa Aslam, a GP in Tower Hamlets, London – ‘The promise of extra funding is great news and will give primary care a much needed boost in a time where it is under huge pressure and near collapse. I am worried about the premise that GPs will need to prove their worth and that practices may be put in league tables to rate performance. In exchange for the additional funding the health secretary wants GPs to provide more access and appointments. I am not sure how this will be possible given how stretched and under resourced we already are.’
Dr Rumina Önaç, a GP in Yorkshire – ‘Today’s announcement is the usual Government bluster designed to pander to a campaign of attack against GPs who are already stretched beyond breaking point. Mr Javid has conveniently forgotten that the NHS rolled out the vaccination programme. It’s vital the public know that the carefully considered adaptations we have made in general practice are all to help reduce the spread of the virus – something the Government itself has utterly bungled. Mr Javid should apologise for his thoughtless comments and ill-conceived plan.’
Dr Mike Smith, a GP in Hertfordshire – ‘This is a rather razor-edged life ring for GPs with vague pledges on GP abuse, infection control and funding, but the name and shame element is disappointing and cynical. Rather than looking at the root causes of poor access and emergency admissions (such as workforce, local deprivation and availability of other health services), struggling practices will be effectively having their fingers ripped off the last rung of the ladder. Well meaning? Possibly. Misguided? Certainly Hazardous? Definitely.’