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Wake-up call



How long can general practice keep delivering the booster programme while facing fresh targets and dealing with media and government hostility, asks Dr Manu Agrawal

We’ve come a long way since I wrote last time about the reorganisation in the NHS in the middle of a pandemic. 

The booster programme is in full swing. There are proposals that under-40s will also have boosters, and by the time this column is published that process will probably have started.

So where does this stop? How long can general practice continue delivering the booster programme? How long can a profession on its knees continue propping up the NHS? 

The staff are exhausted. Winter is in full swing. The flu season and RSV seem set to create unprecedented demand on general practice, and Covid is still around. 

To top it all, NHS England and sections of the media are hell-bent on blaming all the NHS’s problems on GPs. Staff morale is at an all-time low and abuse from patients is rising. 

We still have QOF to deliver, and we also have a shortage of the tubes used in blood tests, caused in part by increased demand in the pandemic. Then there are PCN targets.

I’m not going to discuss whether PCNs are a good or a bad thing for general practice. With a change of fortune and strong leadership from LMCs, the BMA General Practitioners Committee and the BMA itself, they will either not be here in the future or be significantly watered down, which should provide some hope for the independent contractor model. But for now, they are here and we have the Investment and Impact Fund (IIF) targets to contend with. 

Practices are stretched, clinical directors (CDs) are stretched, the PCN workforce, which is so varied across the country, is stretched.

No wonder any new targets in the IIF create a sense of desperation, however meaningless they might be in the middle of a national health emergency and NHS emergency.

I could go into the criteria in the IIF, the points and the funding, but to be honest, I can’t be bothered at the moment. 

Are these targets helping anyone? Especially patients? They’re taking away valuable clinical time from front-line care.

I know practices and CDs will somehow pull this out of the bag. We always do. But it’s coming to the stage where people have now started questioning the relevance and motives behind all this.

The motives couldn’t be clearer than in the NHS England letter to practices on October 14, titled ‘Our plan for improving access for patients and supporting general practice’. It outlines the requirements for the Winter Access Fund, intended to increase access and resilience, which have been roundly criticised by the profession for being punitive.

Put everything together, reflect and ask yourself, what will end first? The useless targets, the vaccination programme, the media and government rhetoric, this never-ending erosion of general practice or general practice itself? 

I have a fair idea which it will be if we don’t wake up. 

Dr Manu Agrawal is clinical director for Cannock North PCN, Staffordshire, senior partner managing three practices in three PCNs and chair of South Staffordshire LMC