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‘We must ensure any new contract puts continuity above targets’

‘We must ensure any new contract puts continuity above targets’

In his speech at the England LMCs annual conference, GPC England deputy chair Dr Kieran Sharrock says the BMA and LMCs need to prepare the ground for industrial action. Read the full speech below

Conference, unfortunately we meet today with the profession continuing to face unprecedented challenges. Challenges that we hoped would have abated following the easing of the pandemic. However, this is not the case. We are working harder than we have ever done before.

We now deliver over 28 million consultations each month, compared to the 24 million each month before the pandemic. You tell us that you and your colleagues frequently undertake 60, 70, 80, 90 consultations per day. This is not safe for you. This is not safe for your colleagues. This not safe for your patients.

We are delivering ever more with an ever-decreasing workforce. In 2019, the Government promised us 6,000 more GPs by 2024. Instead, we have lost over 380 GPs from the workforce over the last year, and around 1,900 since 2015. The Government appears to have quietly dropped this commitment, to avoid the humiliation of failing to deliver one of its key manifesto pledges.

To add insult to injury, parts of the media seem intent on vilifying us at every turn. We have now become accustomed to being accused of ‘hiding’, refusing to see patients face to face, or having empty waiting rooms. We all know this is false, and that the truth is that we are instead delivering ever more, with ever less.

We are where we are because successive governments have failed to listen to us. We haven’t been listened to on the burden of bureaucracy. We haven’t been listened to on the need to reform pensions. We haven’t been listened to on the workload shifting from secondary care trusts. We have not been listened to on the value of a GP who knows their community, knows their patients, and provides continuity.

Increased workload, reduced workforce, and negative rhetoric leads to cumulative strain on our wellbeing. We know all too well the tell-tale signs of being overworked and beginnings of burnout: we leave our practices late, exhausted and drained. Two-thirds of GPs report suffering from either depression, anxiety, stress, burnout, or emotional distress linked to their work.

The death of Dr Gail Milligan earlier this year was not the first in general practice. We have a duty to remember Gail and other colleagues, by taking every effort to protect the wellbeing of all our colleagues in general practice.

Practices innovate, we are tenacious and resilient. We are committed to our patients, so we carry on. But we know that this trajectory for general practice cannot continue if it is to survive. We know that overworked, stressed, burnt out doctors are leaving the profession. For every doctor that leaves or reduces their hours, there are patients with less access to their family doctor.

This is why as an officer team, three of our key priorities are workload, workforce, and wellbeing. We have started taking action to address these priorities, but we know there is much more to do.

In September, we called on practices to take time out of their schedules, to discuss as practice teams how their wellbeing has been impacted by our workload, and what steps we can take to protect ourselves and support each other. As an officer team, we don’t want this to be a one-off, we want this to be a recurring feature in practices. This is why we will continually be emphasising wellbeing and improving our support to members and practices.

To help you manage your workload we have updated our safe working guidance. This provides practices with practical suggestions so that they can take control of their workload, whilst adhering to their contractual requirements. 25 to 35 contacts per day per GP is what is safe, so for our wellbeing, and that of our patients, we have to find a way to return to this safe level of work.

To achieve this target we may have to open up our appointment books, and book patients further in advance. We know that there are anxieties about taking such measures, and the impact it can have on patients. But we are the only ones who can take action to control our workload, protect our wellbeing, and guarantee the safety of the care we are delivering to our patients.

We need your help, the help of LMCs, to engage with the practices in your areas to support them to if they want to implement this change. We must all work together to protect the wellbeing of our GP colleagues, practice staff, and patients.

But we know that the ills of workforce, workload, and wellbeing cannot be cured by LMCs and practices alone. The solution to general practice’s ills lies in a reformed national contract with increased investment.

We need a contract that frees you from unnecessary bureaucracy. Bureaucracy which leaves GPs and their staff, chasing countless and ever less-valuable pots of funding.

We need a contract that recognises your professionalism, expertise, and ability to work autonomously, without endless monitoring and targets.

We need the Government to move to a high-trust, low-regulation default for our contracts so we can focus on what both we and patients want: delivery of safe patient care.

To this end, in upcoming contractual negotiations for 2023, and particularly 2024, we will be prioritising reducing bureaucracy at every turn and increasing flexibilities. To allow you as highly trained professionals to exercise your professional judgement over the most effective way to deliver services.

We need a contract which enables us to effectively manage our workload, so we can provide high-quality, continuity of care which we know patients value above everything. Continuity of care is valued by patients, valued by GPs, and is the most valuable principle of general practice. This principle has been eroded by unrelenting workload. We must ensure any new contract puts continuity above targets.

The PCN DES is too burdensome. Many practices cannot see the value, many cannot recruit. Practices feel compelled to stay in the DES solely for the additional funding which is keeping them afloat. We have produced guidance to help practices to consider whether on balance the DES is a benefit or a burden. We encourage all practices to review this, and decide for themselves whether to withdraw.

On ARRS we have made some limited progress. Through our lobbying we have secured a relaxation of the restrictions around how funding for ARRS roles can be used. This has to be just the start, practices must be able to choose how they use the funds to recruit the people they need.

Contractual reform is essential but alone will not achieve what we need. We need significantly increased investment in all aspects of general practice. We cannot shoulder the burden of the inflationary pressures we all face. We need investment to improve our cramped and crumbling premises. We need our valued staff to have the fully funded pay increases they deserve.

We know that up to 90% of healthcare is delivered by primary care, so why do we receive only 8% of the NHS budget? We need a level of investment in general practice, which better reflects the volume of care we deliver.

So, is there a light at the end of the tunnel? I would now like to quote from the health select committee report into general practice published in October:

‘It is time to recognise the need to make the job not just manageable but once again fulfilling and enjoyable.’

And more: ‘To do that general practice needs to have its professional status restored with a decisive move away from micromanagement…’

We fully support these words, penned under the chair of Jeremy Hunt, now the Chancellor.
We call on the Government, and the Chancellor, to honour these words with action. Engage with us to agree a new contract that delivers for patients, practice staff, and GPs.

Engage with us to deliver a new contract that gives GPs control of their workload so that they can deliver safe care to their patients and protect their wellbeing. A contract that dramatically reduces the bureaucratic burden placed on practices. A contract that increases the investment in core funding. A contract which places and trust in GPs to exercise their professional judgement over how to deliver services and care.

This is what we will be pursuing through the 2023 and 2024 negotiations. If the Government honours the words of its Chancellor, we are confident that we can deliver this.

For good or bad, when we have a negotiation outcome we will come to you and the wider profession to say ‘yes’ or ‘no’. The final decision on a new contract will lie with you and our colleagues. It is crucial that we are confident that any new contract has the support of the profession before it is implemented.
The light at the end of the tunnel seems a long way off, but it is there. But what if that light is a false dawn? What if government ignores the wise words of the health select committee? Will the profession be prepared to act? If we ballot the profession on industrial action will the profession say ‘yes’, and will the ‘yes’ be loud enough for it to be heard by government?

Together, BMA and LMCs, need to prepare the ground for action. Together we need to go out and ask what action our colleagues are prepared to take. We need activists in every LMC who can build support and understanding of industrial action, so we can turn back on the light at the end of the tunnel.
We need a general practice that cares for the wellbeing of its staff, as much as its staff care for the wellbeing of their patients. We need a general practice that allows you to thrive as GPs.

General practice cannot continue on its current trajectory if it is to survive. If we cannot agree with the Government a contract that delivers, then we must be prepared to take collective action to protect the bedrock of the NHS, which is general practice.

To make progress we must be united as a profession. We must be cohesive as a profession. We must speak with one voice as a profession. We are far stronger together as a profession.

Thank you, conference.