Practice managers, GP leaders, MPs and policymakers debated patient expectations around GP access at the launch of a new white paper by Management in Practice and its publisher Cogora this week.
The Access All Areas report was unveiled at a Labour Party conference fringe event in Liverpool co-hosted by campaign group Rebuild General Practice.
In a session chaired by report author and editor-in-chief of Management in Practice’s sister publication Pulse Jaimie Kaffash, attendees heard from a panel featuring Dr Simon Opher, Labour MP for Stroud and a practising GP; Dr Samira Anane, BMA GP Committee England deputy chair, portfolio GP, PCN clinical director in Manchester; Dr Lisa Harrod-Rothwell, GP and Londonwide LMCs chief executive; and Rosie Beacon, head of health at public services think tank Re:State. Panellists spoke about what constitutes access and differing interpretations among GPs, patients and the wider public.
The white paper is based on a survey of 2,000 general practice staff, interviews with more than 100, and an analysis of more that 25 data sets on each GP practice in England.
Survey results showed that almost half of GPs and practice managers see continuity of care as being a bigger priority than waiting times, ease of contacting the practice, offering face-to-face and on-the-day appointments.
Ms Beacon said: ‘I would probably challenge the notion that a patient should see who they believe they should see.
‘I obviously would have a preference to see a GP every time I had a clinical need, but no, but I don’t need to see a GP if I have a UTI – I just don’t.
‘That appointment could go to somebody who needs it much more than I do, and has much more complex needs, and actually does need to see an expert generalist.
‘The NHS doesn’t exist in a vacuum, and we can’t hire hundreds of thousands more GPs just because some patients have a desire to see a GP more than they do a nurse practitioner.
Unfortunately, it’s just not cost sustainable. It’s only going to get more expensive over the next 10 years as people get older and people have more long-term conditions, the majority of the burden of which will fall on GPs.’
Some panellists questioned if the vaunted increase in access for patients following the 1 October contract changes may have the opposite effect.
Dr Harrod-Rothwell said: ‘Demand will outstrip supply. The people who generally need our services the most are the people who find those online mechanisms the hardest to use. We’ll be talking about people who maybe have disabilities, who are maybe older.
‘You’re reducing the threshold of being able to access care, because rather than say, ‘is this worth hanging on the phone for’, we now can just press submit at three o’clock in the morning. But those who tend to need us the most can’t do that.’
Meanwhile, Dr Anane spoke about the benefits and challenges of adopting technology to aid with access, and she elaborated on the reasons for the BMA’s new dispute with the Government over new online access requirements for GPs in England.
She said GP practices required ‘carrots’ and nudges to create the correct framework that enables people to default to the safest way of using the technology, rather than pressing a button overnight, which then creates a lot of danger.
‘Where our dispute with government lies is that we haven’t got that framework, and that is why patients will be at risk.
‘If you were going to bring out a drug, you wouldn’t just prescribe it, you would test it. Part of the issue is that we’re in a very finite and stressed environment, and we’re looking for silver bullets.
‘There are vested commercial interests that are driving some development, because they are testing their financial flows that aren’t coming into the NHS and necessarily benefiting patients directly. We need to be clear what the criteria and frameworks are that are designing and then implementing and deploying that.
‘We’re not Luddites in general practice – we are at the forefront of accepting and embracing innovation technology – but we want to do it safely.’
Edward Rigby, a managing partner at a practice in Cheshire, later said that rushing through conversations about changes that affect people’s care is a risk.
‘It’s a worry for some practices particularly triage-based practices. Mistakes might be made, there is a safeguarding perspective. And some patients might find they are just “bumped down the line” a bit.’
In all, 41% of GP practices surveyed for the white paper said they would need to reduce their patient list size to provide the level of access they would ideally like.
Mr Rigby, who is also the Cheshire representative of the Institute of General Practice Management said there are systemic issues preventing good access in some surgeries.
‘These include sustained underfunding, increases in pressures such as around meeting targets and a lack of flexibility to work in the way we think best serves our patients.’
He also called for practice managers to be involved in decisions on models of service delivery at the design phase so they could influence outcomes.
‘There is a default position to consult via the traditional model via the LMCs and so on. This is right because they review things clinically. But not all LMCs have practice manager representation, so when they put out requests for new services or reporting models we don’t always get a say until they have been published and we just have to deal with what’s left.
‘I would like practice managers to become co-creators of the work we are trying to achieve at system level.’
Parts of this article were first published by our sister title Pulse
You can find all the data and the methodology in the full report, which can be downloaded here.
Commercial partner of this white paper: General Practice Solutions
