BMA GP Committee chair Dr Richard Vautrey’s opening speech to the UK LMCs conference, 11 May 2021:
When this conference last met two years ago none of us could have imagined what lay ahead. None of us could have imagined the locking down of our whole society, of the radical change in the way we would need to work, of the significant change in priorities, of the global nature of the pandemic, on the prolonged impact it would have on the health and lives of countless people and sadly of the scale of the number of people who have died and those left to grieve the loss of loved family members, work colleagues and friends.
It has been a hard and difficult time that has left many physically exhausted and mentally drained. It’s tested every GP team and individual like never before. But it has shown the profession at its best. We have been there for our patients. We have not let them down. We have responded to this unprecedented situation and we have risen to and met the challenge.
Thank you, once again, to all of you, to the whole general practice workforce, and to all LMCs in all four nations, for all that you have done, and continue to do, because we know we are not at the end of the pandemic yet. And thanks too, on behalf of myself and the other GPC chairs, Alan, Andrew and Phil, for the immense and vitally important work done by our executive and negotiating teams, our policy leads and sessional and trainees committee chairs and to all those who support our work in the four national BMA teams. We could not achieve what we have this year without you.
After a terrible winter, thankfully at last there are now fewer people with COVID-19 and we are on a road to relaxing restrictions across the UK, but we are right to be wary about the potential for further waves of infection in the year ahead. Our experience over the last year means we cannot let our guard down and we will need to continue to be prepared for the worst, but as a result of the incredible response from practices across the country millions of people have now been vaccinated, not just once but increasingly twice, and as a result given significant protection against this deadly infection.
The remarkable achievement of delivering the covid vaccination programme so quickly and effectively despite all the challenges and difficulties, and after also delivering the biggest ever flu vaccine campaign, is down to the dedication and hard work of so many people in general practice. The nation owes you a huge debt of gratitude. But it’s also a sign of the strength and benefit of the independent contractor model of general practice, something this conference has repeatedly highlighted year after year.
That does not mean we are somehow private practitioners as some in government at times ridiculously suggest when they are trying to make an excuse for the involvement of private companies in the NHS – far from it, we have NHS written through us like a stick of Blackpool, Edinburgh, Carnarvon or Portrush rock. We are the bedrock on which the NHS is built. Private companies come and go depending on their profit margins and shareholders; we will be here for the long term. Our special status does though mean we are flexible and adaptable; we can respond to the needs of our patients quickly and effectively; and because we are at the heart of each and every community we are trusted by those we work for each and every day.
General practice offers the flexibility for doctors to choose salaried, locum and partnership options which can all be ideal at different stages of a career. The variety of options we offer doctors to be a GP is one of the great attractions of general practice. But we must ensure that all options are available to all doctors. UK practices should not be able to be sold as a commodity, like a football club to American firms and then deny the opportunity for GPs to become partners in the practice. For being a partner in a practice is a privilege and a great responsibility, but its also professionally fulfilling to be able to both involved in decision making and work in teams of wonderful and committed people. It’s a model of working that has served the nation well for generations, and that’s why we need to do more to enable more GPs to have that opportunity and why the governments, particularly in England, need to do more to maintain local ownership.
The partnership premium schemes introduced this year in England and in Wales are starting to pay out significant sums of money to new partners and are giving more and more new GPs the opportunity to get the necessary skills and confidence needed to be a partner. We do though need to do more as a profession to give every GP that wants to become a partner the opportunity to do so. Expanding the number of partners is also one important way to address the gender pay gap that exists in general practice, so every partner and every practice should be considering the future, and doing all they can to give the salaried GPs in their practice the chance to join them in their partnership.
We began this pandemic badly weakened for what was to come by a decade of underinvestment and with too few GPs and too few practice nurses; and as we reach this stage of the pandemic we still have too few GPs and too few practice nurses. Despite the important strides we have made to use new funding to begin recruiting pharmacists in to every practice, whether that’s through primary care networks, federations or health board pharmacotherapy services, alongside a growing number of other healthcare practitioners working alongside us and sharing our workload pressures, we still need a significant focus on recruiting and retaining more GPs and practice nurses. It’s great to see, at long last and after the hard work we’ve done to address this, increasing numbers of doctors choosing general practice as a career and becoming GP trainees, but we need far more to be done to support GP retention, and the Westminster government’s short sighted and shameful freezing of the pension life time allowance will do nothing to help with that, and could very easily make matters worse.
To compound the problem the Treasury has also failed to use the spending review to invest in practice premises development, something that is urgently needed in each nation. There is little point recruiting an additional 26,000 people, as we plan to do in England for example, if we have nowhere for them to work or to consult patients from. In Northern Ireland some practices have seen a significant increase in health centre charges and in England many are subject to the unjustified charges levied by NHS Property Services, again a problem of the government in England’s own making but which acts as yet another disincentive to continue as a GP.
And how can we build on the experience of the pandemic and enable more people to work flexibly from home, particularly locums and those with other commitments but who are willing to help practices, if the Treasury fail to budget for the IT necessary to do this? Billions can be found for Test and Trace, its time to invest more in something that really works – UK general practice.
Appointment data everywhere clearly demonstrates that practices are well and truly open, working as hard, if not harder, than ever, with millions of consultations every week. In England the latest data shows that practices have delivered more than 5 million more appointments in March than February and nearly 3 million more than the equivalent time 2 years ago, and they don’t include the huge number of appointments provided for covid vaccinations on a daily basis. These figures underline the immense efforts that practices are making in providing care to their communities, but also reflects the intense workload pressures that staff are now under as we continue to respond to the pandemic alongside patients’ wider health needs.
But this data only tells part of the story. It fails to show the complexity of what we deal with each day. It fails to show the additional activity, the growing number of prescriptions reviewed and signed, the large amount of investigations processed. It fails to recognise the intensity and pressure on our reception staff dealing with huge numbers of telephone calls and the rapidly growing number of e-consult requests. It fails to recognise the shifted work and the need to manage far more patients waiting for procedures or appointments as general practice is impacted by the serious backlog in work in secondary care and elsewhere in the system. And it fails to show the bureaucracy that we and our practice managers still have to contend with but which somehow alongside everything else we manage.
It was helpful in England in the last year not to have to contend with unnecessary CQC visits, chasing local targets and ticking QOF boxes as income protection arrangements were in place and we were enabled to work far more as the professionals we are, trusted to deliver the care that our patients needed. In Northern Ireland, Scotland and Wales QOF has either been removed altogether or will be continue to be suspended, and patients are no worse off as a result, but in England the obsession with targets remains and whilst the delay in PCN service specifications, the additional funding for clinical directors, and the further £120m following the earlier £150m investment that we secured to support practices was welcome, the reintroduction of QOF and a suggestion of a return to so called “business as usual” in the midst of an on-going pandemic is not.
The work we are doing with Professor Sir Mike Richards on community based diagnostic hubs in England is important, with the plan to create sites that could help improve access to diagnostics both for primary and secondary care clinicians, and by doing do reduce the unfunded shift of work to practices. Similarly in Scotland the Memorandum of Understanding multi-disciplinary team services need to be rolled out quicker to increase the capacity of primary care and improve access for patients seeking help in the community, and in Northern Ireland the programme of expanding the full multidisciplinary teams needs to continue.
For we are not out of the woods yet, not by a long way, and so we cannot be expected to work as if we were. We must not raise patient expectations that everything will magically return to how it was in 2019 and that we will now be able to do what we did then and in the way that we did it. We and our staff need time to rest and recharge, to recalibrate our mental and physical health. We need protected time to reflect on what has happened and enable us to consider new ways of working going forwards. We need to retain the modified appraisal system that has reduced workload burden and focused on wellbeing rather long lists of CPD reflections. And just like everyone else, we need a holiday and meaningful time to be with our friends and family, but with an overwhelming backlog to deal with, unreasonable expectations placed upon us, or lack of funding to take on locums for backfill cover, it’s going to be hard for individuals, practices, out of hours providers and other primary care bodies to recover.
We don’t just need our patients’ understanding, we have often had that throughout this last year, we need governments to act. Not just with letters of thanks, which have been welcome, but with real and meaningful supportive action. We don’t just need short term fixes, but a long-term commitment to investment and development of general practice, to properly redress the years that have left us as we are. We cannot allow another crisis to hit us without being better prepared.
This conference agenda clearly demonstrates that there is much to learn from the last year, but also much to do to address the problems for the future, not least the unsustainable workload pressure we currently experience. I can assure you that your GP committees across the UK, in England, Northern Ireland, Scotland and Wales will continue to do all we can to support you and support the profession as we work together for all our patients.