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Access Denied? Primary Care Reacts to Winter GP Plan

What has been announced?

The culmination of weeks of concerns about the coming winter, how GP surgeries operate, how they balance online and face-to-face appointments, and how they manage patients and their expectations have prompted a response from the government, in the form of a plan for improving access for patients and supporting general practice. Published today (October 14th), it contains information on what is likely to happen over the next few months, what local bodies are expected to do, and by when.

What is the government trying to do here?

For patients, the Health Secretary says he wants them to be able to see the doctor in the ‘way that they prefer’. The document states the need for more face-to-face appointments; “a minority of practices are now offering wholly inappropriate access, with very low levels of face-to-face care. In August 2021 over 15% of practices recorded less than 20% of their GP appointments being held face to face.” (Before the pandemic, over 80% of patients were seen in person). It goes on to say that this is contrary to good clinical practice, though admits that there is ‘limited evidence-based standards’ to prove what is or is not acceptable in this regard.

It also sets out a winter plan for more referrals to Walk-In/Urgent Treatment Centres (UTCs) instead of hospitals or GP Practices (supported by urgent care funding), along with the use of NHS 111 “where general practice is unable to expand”.

For NHS staff, the government is keen to show it has new ideas and new money to back them up, and that it understands the pressure that staff face. It also wants to be seen to be trying to avoid overwhelming hospitals and A&E departments, as A&E performance is now rated the worst it has been since 2004.

There are 3 main focus areas in the plan:

A. Increase and optimise capacity

The figure that has made headlines has been the £250m Winter Access Fund. Its basic aim is to ensure patients with urgent needs are seen at the right time, and in the right place, i.e. avoiding unnecessary hospital admissions. Its two specific aims are:

(1) to drive improved access to urgent, same day primary care, ideally from patients’ own general practice service, by increasing capacity and GP appointment numbers achieved at practice or PCN level, or in combination.

(2) to increase the resilience of the NHS urgent care system during winter, by expanding same day urgent care capacity, through other services in any primary and community settings.

The other measures designed to increase and optimise capacity include (1) recruitment of further GPs and other staff, (2) moving to cloud-based telephony - trying to improve on the figure of a quarter of practices who already use it, and mentioning a “national solution” by year end (though caveated with the label ‘short term’); making best use of community pharmacies; redirecting capacity from locally commissioned services; and the planned transfer of current CCG-commissioned extended access services to PCNs will now be postponed until October 2022 to prevent disruption.

  B. Address variation and encourage good practice

The aim here is for practices to strike that holy-grail balance between in-person and remote consultations. To help them, NHS England and DHSC have requested that the RCGP consider providing a further update to its guidance to practices by the end of November. There will also be an additional QOF improvement module on this subject.

There will also be a new push to expand the Access Improvement Programme - starting this month, a new intensive form of the programme will support 200 practices experiencing the greatest access challenges.

C. Zero tolerance of abuse and public communications

The plan is careful to state at the outset that although patient frustration may be understandable, it is never OK to use violence or be abusive. Restating the zero-tolerance approach may disappoint some, but there is a proposed toughening of the maximum prison sentence for common assault to be doubled to two years if the victim is an NHS worker. There is also new money here; NHS England will immediately establish a £5m fund to facilitate essential upgrades to practice security measures, distributed via NHS regional teams.

What do I need to do, and by when?

By Thursday 28 October, local bodies should have developed and submitted their plans for using the Winter Access Fud, assured by their ICS board. This should “determine the optimal use of the funding in line with local issues and solutions, national expectations and requirements”.

By the end of October, the government expects all practices to have completed an exercise to review the balance they provide between remote and face-to-face consultations, and to have taken steps to improve the quality of their data reporting. This should be part of ongoing reflection on professional practice and surgery management rather than a reporting exercise.

What are the main concerns that have been raised?

Dr Richard Vautrey, of the British Medical Association, was ‘horrified’, pointing out that despite the media narrative, face-to-face appointments were still a key part of GP care, and that video appointments were appreciated – and appropriate – in many cases.

Other doctors want to move away from always talking about face-to-face appointments, when there simply aren’t the staff to guarantee this, and when telephone or remote appointments often entail much shorter waits.

There is concern that the government plans to publish GP appointment data at practice level by spring so patients can rate their performance, with the Health Secretary having to publicly deny this would amount to GP league tables.

Finally, many have wondered how simply increasing the money available will make a tangible difference, when it is increasingly difficult to find locums, and the GPs and other staff who are working are suffering their own work-related stresses and even illnesses.

Where can I get further information and support?

FPM Group will be working to support all of our members in GP practices through our HR helpline , policy library and HR coffee mornings. Join the conversation on our Facebook and Twitter pages, or drop us a message at mail@firstpracticemanagement.co.uk to let us know your thoughts.

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