This is my comment posted on the FT page to “Its Time to Stand Back and Ask What GPs are For’ Camilla Cavendish.
“This has subtly misrepresented our work. People who are ‘struggling with life’ are primarily poor. This is not about delegating that work to someone else. Poverty cannot be fixed with an NHS appointment – but it can be fixed with a universal credit system that does not leave people struggling to cope. The issue we raise is that the NHS providing a sticking plaster to poverty is much more expensive than ensuring we are not leaving people in poverty. In addition this is something communities can help with, supporting people who have no social connections. Where people have friends they use health services less. Overall delegating poverty driven health problems to other workers is not the solution. This is not something it is within the gift of general practice to solve and it is misleading to say it is.
Linking this to the face to face appointment issue is also misleading. We have been working pre-pandemic on a much better mixed model of telephone, video and face to face appointments. This means more people can be seen, and for many many people video consultations are both effective and meet their needs. In fact patient satisfaction with video consultations is really high. There are face to face appointments available with GPs but they are triaged ie only those that need it – and that means General Practice can see many many more people. You can’t advocate for delegating work on the one-hand and then saying there must be more f2f on the other – its a contradiction. We understand that general practice is now running at at least 110% from pre-pandemic. The demand from Long Covid, people waiting for hospital care, people who have waited with their concerns until they felt safe to see the NHS front door, anxiety and mental health issues from the pandemic, alongside the regular GP workload means if General Practice is to manage and see those that really need their services they must ‘filter’ early (so they can delegate as you suggest where relevant) and then work out who to see f2f and who virtually, providing information so patients can make a choice as they do so.
This article mixes the issues and contradicts itself. GPs know they need to develop a new model of primary care, and they need to do this based on local people’s health needs not a whole set of assumptions about what they are and are not doing. Given the huge increase in workload across the NHS, GPs need support to (a) understand the needs coming through the door (b) to work with community leaders to help communities help themselves (c) time and space to redesign general practice and (d) the causes of poor peoples health needs to be properly addressed (see Marmots work which sets all this out – https://www.instituteofhealthequity.org/home).
We work with GPs in the evenings on how better to deliver care; they are doing this at the end of the day after 6pm having had a full day in surgery. They are having these evening conversations because they care, even though they are absolutely exhausted. GPs are not immune to peoples needs, they are highly tuned to them. Why are journalists making out GPs are turning their back on people when they are working non-stop to see them. One GP was telling me she had 200 calls to make in 2 hours last week. Thats the level of demand.
If you look at management in the UK business sector it runs at 9% of total costs; in general practice its less than 1%. We have one of the lowest doctor to person ratios in the western world. General practice management and development has been underinvested in for years. The new roles coming into general practice really help but they are not the whole solution. Tackling poverty would really really help. As would a more managed approach to the community spread of Covid.
Alongside all the issues I have covered General Practice is also coping with Covid running rife through its staff now there is so much community prevalence – no-one talks about that. Once practice I worked with last week had 7 staff members off, and one GP suffering long covid not able to work for 2 months. Given the crisis in recruitment of GPs thats work that has to be managed by the rest of the staff in that practice. GPs are coping with a pandemic response that has no plan for General Practice, a hugely increased workload, and is trying hard to adapt to do everything it can to meet needs effectively. Relentlessly criticising GPs in this context is really unhelpful, as is grasping for simple political solutions. Its hard to understand why the media is not helping general practice by sharing the real story of whats going on in surgeries across the country. General Practice needs the community to help, fuelling the fire of disenchantment will not solve the problem. Neither will a simple fix reorganisation of how General practice is structured. Right now communities need to help general practice look after those that really need it and get through this winter. “
Prof Becky Malby
Becky Malby 