GP leaders have reacted with dismay towards health secretary Dr Thérèse Coffey’s new Our Plan for Patients, which has improving access to general practice as its ‘centrepiece’.
BMA GP Committee England chair Dr Farah Jameel:
‘It is good to see a health secretary who acknowledges that there is a problem with general practice. But she could solve this better with meaningful dialogue and constructive engagement with GPs rather than yet another a new set of ill-advised undeliverable targets.
‘As clinicians, day in, day out we watch our communities suffer the harms of poorly thought-through headline-grabbing government announcements. These may be well-meaning but don’t address the fundamental issues. Many practices already use cloud-based telephone systems, but we simply don’t have the staff to answer more phone lines, nor more clinical staff to offer more appointments. The promise today to free up over around 3 million appointments per year is equivalent to just two-and-a-half extra days’ worth of general practice activity in England – or less than 1% more than we deliver already.
‘Despite delivering over a million appointments a day with the lowest number of GPs we have ever recorded, we continue to struggle to deliver the care we know our patients so desperately need. GPs and their teams are already doing everything they possibly can to see those patients with the most need urgently. Despite this, we know there are so many more patients who cannot access their GPs in a timely fashion.
‘The target of GPs now offering appointments within two weeks is simply another addition to a tick-box culture highlighting a tone-deaf government approach when it comes to those delivering the service on the ground.
‘GPs need to be freed up to deliver the care that we know patients so desperately need – that means we need a genuine strategy to address the workforce crisis. There simply aren’t enough GPs and staff to deliver the care our patients need and deserve.
‘Today’s GP workforce data shows that between August 2021 and August 2022 we lost the equivalent of 314 full-time GPs. We now have the equivalent of 1,850 fewer fully qualified full time GPs than we did in 2015, with 16% more patients per GP. We are losing more GPs than we can recruit and this combined with cost of living pressures is starting to spell the end of GP practices as we know them.
‘Without concrete action on recruitment and retention – most urgently an amendment to the Finance Act to address the perverse impact of inflation on pensions, leading doctors to retire early this year – we are simply not going to have the numbers to provide any service let alone fulfill any of the ambitions stated here.
‘If the new health secretary had met with us before this announcement we could have suggested a workable strategy to address the unfolding crisis before us for this winter and beyond – instead we have in reality minor tweaks that will make no tangible difference to patients struggling to access care.’
RCGP chair Professor Martin Marshall:
‘It’s a shame that the health secretary didn’t talk to the College and to our members on the frontline before making her announcement because we could have informed her of what is really needed to ensure a GP service that meets the needs of patients and is fit for the future.
‘Lumbering a struggling service with more expectations, without a plan as to how to deliver them, will only serve to add to the intense workload and workforce pressures GPs and our teams are facing, whilst having minimal impact on the care our patients receive.
‘Access to our services is important, but it is only a starting point to ensuring our patients receive the safe, personalised, and appropriate care they need. Around 85% of appointments in general practice are already happening within two weeks of being booked, with 44% being delivered on the day they are booked – both higher figures than in 2019 – and those taking longer than two weeks after booking may be routine or regular appointments for which the timing is therefore appropriate.
‘GPs share patients’ frustrations when we cannot deliver the care we want to deliver in a timely way. But we are caring for an increasing number of patients, with increasingly complex health needs, and carrying out more consultations every month than before the pandemic – yet with fewer qualified, full-time equivalent GPs than in 2015.
‘We also need more details about the proposal outlined to publish more practice-level data. Whilst we support transparency we strongly caution against creation of “league tables”, which we know from international research evidence do not work in improving access to or standards of care. Different GP practices will serve different patient demographics, who will have differing health needs and services will be tailored to meet these. Introducing arbitrary performance rankings compares apples with pears and will only serve to work against and demoralise those working in practices that ‘rank’ lower.
‘General practice is the bedrock of the health service with GPs and our teams delivering the vast majority of NHS patient contacts and in doing so alleviating pressures across the health service, including in A&E. Our service needs to be protected and we have been calling on the Government for a bold plan that recognises the crisis facing general practice and to take urgent action to address it for the sake of our patients and the wider NHS.
‘Today’s announcement is not a plan. We need to see the implementation of a new recruitment and retention strategy that goes beyond the target of 6,000 GPs pledged by the Government in its election manifesto, funding for general practice returned to 11% of the total health spend, investment in our IT systems and premises, and steps to cut bureaucracy so that we can spend more time delivering the care our patients need and deserve.’
Labour shadow health secretary Wes Streeting:
‘She says that patients will be able to get a GP appointment within two weeks. Her party scrapped the guarantee of an appointment within two days that Labour introduced when we were in government. And she made it clear this morning: this isn’t a guarantee at all, merely an expectation.
‘And what is the consequence if GPs don’t meet her expectation? Well, as we heard on the radio this morning, her message to patients is get on your bike and find a new GP.
Are patients supposed to be grateful for this? Who will deliver these appointments she’s promising? The 6,000 GPs her party promised at the last election, but won’t deliver? Or the 4,700 GPs her party has cut over the last decade?
And where will these GP appointments take place? Well, it certainly won’t be in the 330 practices that have closed since the last general election.
‘The Conservatives promising to fix the crisis in the NHS is like the arsonist promising to put out the fire they started. And if that weren’t bad enough, the supermassive black hole at the heart of her plan is the lack of a workforce strategy. She has no plans provide the doctors that our NHS so desperately needs.’
GP Survival chair Dr John G Hughes:
‘While many groups and individual doctors have expressed their disappointment at the “plans” for the NHS announced by Dr Thérèse Coffey, I would take a stronger stance and express my serious concern at the deliberate misinformation and misrepresentation of general practice.
‘The initial press release, widely trailed by all media, stated that GPs would be “required” to offer all patients an appointment on request within two weeks, regardless of clinical need.
‘The actual statement changed the wording to “expected”, but by this stage the damage was done.
‘Further clarification appeared to suggest there were no actual sanctions that would be imposed for failure to meet this unachievable expectation, however the public and press were already convinced that this was a contractual requirement.
‘The difficulty with this spin scenario is that it has yet again stoked public and patient expectations that GPs must deliver an unachievable target, and this is almost certain to further fuel aggression and assaults against practice staff when patients are told they cannot have this unrealistic access with current underfunding and workforce shortages.’
Nuffield Trust director of strategy Helen Buckingham:
‘The Government is right to be looking at ways to ease pressure on GP services – whether through an expanded role for pharmacists, using different staff within a GP practice, and improving creaking telephone systems.
‘But even if this frees up some of their time, the truth is that we are chronically short of GPs, with the number of GPs per person in England falling year after year. Targets don’t create any more doctors. The success of this proposal will rest on whether the government can genuinely do enough to retain doctors at risk of quitting the profession, as well as how successful it is in recruiting more support staff.
‘The commitment to guarantee an appointment within two weeks may make good politics, but risks applying a one-size fits all solution to a significantly more complex picture. Government should step back from micro-managing timescales for appointments and instead focus on the outcomes they want to see in primary care.
‘With cloud-based telephone systems set to run alongside NHS 111, the NHS app, phoning out of hours and a multitude of other ways to access care, we risk simply proliferating ways for patients to find out the ugly truth of general practice: there just aren’t enough doctors to go around.’
The King’s Fund director of policy Sally Warren:
‘Today’s announcement contains some sound ambitions and sensible measures, but amounts to little more than tinkering at the edges. Despite the best efforts of NHS and social care staff, patients are facing a grim winter struggling to access over-stretched services. The scale of the challenge requires bolder action.
‘The reinstatement of a scheme to help patients off NHS wards and into social care will relieve some of the pressure on hospitals. But social care is much more than a release valve for NHS pressures. A short-term, short-notice pot of cash is not going to help social care services to address unmet need, improve quality of care, or recruit and retain more staff. Social care providers are carrying approximately 165,000 vacancies, and analysis by The King’s Fund shows that nearly 400,000 care workers would be better paid working in most supermarkets.
‘The single most significant reason many people find it hard to access care is the chronic lack of staff across both NHS and social care. This existed long-before Covid struck and has been many years in the making. Many of the other measures announced by the secretary of state, such as extending the emergency registration scheme for retired staff to re-join the NHS, changes to pensions, and a drive to enlist more health service volunteers, are welcome, but they are too little too late to avoid an extremely difficult winter. Addressing the staffing crisis will require a comprehensive, long term workforce strategy, and I hope the government comes good on its commitment to deliver one this autumn.’
Kent LMC spokesperson:
‘General Practice and their teams are working under intense workload and workforce pressures. The statement today from the health secretary Dr Thérèse Coffey fails to address the stress general practice and the wider NHS health and social care are currently under and it is disappointing that it lacks any substantive plan or recognition of the level of care general practice is delivering to patients.
‘In July this year, the equivalent of 40% of the population of Kent and Medway accessed general practice, 810,000 appointments. Despite this, we know we are struggling to meet demand currently and anticipate the demand over this winter will increase. General practice staff are caring for more patients who are waiting to access other parts of the healthcare system, experiencing delays, and are suffering as a result.
‘Government headlines such as these are an attempt to deflect attention from the reality that there is a failure to deliver promises to address the shortage of workforce and resources to primary care and the wider NHS. We continue to see a decline in our workforce at a time when we need numbers to be increasing. Every NHS worker goes to work to support and treat their patients.’