Major structural change is the only thing that will get general practice out of this crisis, says Jaimie Kaffash
I think the best thing we can say about the GP recovery plan is that, considering NHS England have no real new money or power to properly change things, this tinkering around the edges is about the best they can do. On their own, and without being mandated, new telephone systems, fewer prescription medicines requiring a GP appointment and more services that allow patient self referral would be fine, I guess (at least for GPs, if not secondary care).
But new phone systems are mandated and the changes as a whole won’t make any positive material difference to anything. The changes suggested here are tired, and we’ve seen them all before. I’m not going to insult your intelligence by telling you that phone systems aren’t the reason patients can’t access primary care. Staff are still needed to deal with those 400 calls in a day. To steal a soundbite from shadow health secretary Wes Streeting, there aren’t enough GPs and ‘better hold music isn’t going to change that’.
Nothing will change in general practice unless a huge chunk of work is taken off GPs, like when out-of-hours services were removed in 2004. Until then, we will continue to see GPs leaving the profession and not be replaced fast enough. I even have my doubts how far increased funding would go.
The problems are structural, but once again NHS England and the Government are implying that individual practices have the power to make changes. All it takes is better phone lines, apparently. And they have evidence – case studies and pilot schemes from innovative practices. This is standard government and NHS practice. I fear that, in the Government and NHS England’s eyes, all practices can innovate in the way their case studies can, and this can solve the problems in general practice.
But I wish they would put to bed this myth that initiatives from go-getting practices can be rolled out across the country because it is unhelpful in every way.
First thing to say is, this is not a criticism of these practices in the slightest. Those who bring in innovations that actually help the practice and patients should absolutely be commended. Indeed, at Pulse we celebrate them ourselves, and often feature articles on how they achieved success. The problem comes when their examples are applied across the country.
The first problem is that these practices’ solutions are often geared towards their own patient population – a point made by the Academy of Medical Royal Colleges. They don’t tend to be one size fits all, and I think that the telephony systems initiative falls into this category. The recovery plan is at pains to point out that older patients found it useful, but they aren’t the only subsection of patients. Evidence that this works in a few self-appointed practices is not evidence to roll this out across the country and attach contractual requirements to them.
Second, something that is very common with pilot or innovative practices is that commissioners desperately want them to succeed. As a result, they get more attention and get great results. Once schemes are rolled out nationwide, practices who don’t have the initial enthusiasm of the pilot practices and don’t get the attention from commissioners don’t fare so well.
But the third problem is, to me, the most important and most obvious, and brings us full circle. For the vast majority of practices, implementing these changes takes headspace that they simply don’t have. And, while these initiatives might be the right solution for those individual practices, for the vast majority they are simply another bother when all they really need is more GPs and/or a chunk of work taken away.
The reason these plans are always littered with case studies is that they need to be. There is no need for a case study to prove that matching real-terms funding from 2004 works, or show how the practice that was able to recruit six GPs suddenly saw burnout decrease and access improve, or that removing the responsibility for on-the-day appointments led to improved management of long-term conditions.
Major structural change is the only thing that will get general practice out of this crisis. Unfortunately, that seems to be number 140 in the queue when it comes to this Government’s priorities.