GPs are not to blame for all that is wrong with the NHS: Rather than pointing the finger, it would be better to focus on lack of resources and an inability to increase service provision.
The strained relationship between central government and healthcare professionals has come to a head, with tensions running high on both sides. The King's Fund NHS leadership and management summit brought both parties together to analyse the failings of the healthcare system, although the conclusions were not entirely impartial.
The health secretary's tactic of being critical of the primary care system in the face of accident and emergency failings is certainly a high-risk strategy.
Senior GPs are unhappy to bear the brunt of finger pointing – particularly considering the extensive reforms to the healthcare sector that they have weathered, from licence revalidation and pension difficulties to Care Quality Commission (CQC) inspections and new clinical commissioning groups. The reforms have all resulted from government policy rather than sector lobbying, so to criticise those that had no hand in creating the system seems unfair.
What has exasperated clinicians are the series of ill-informed decisions that have defined the care service over the last few years. The chaotic implementation of the non-emergency NHS 111 number demonstrated an inherent lack of understanding when it comes to patient demand. No matter how experienced the GP might be, dealing with a patient on the phone effectively is extremely difficult and makes it virtually impossible to prioritise cases properly – something that is essential if the NHS is to provide a continuity of care to its patients.
In the face of scenarios such as this, pinning all blame on the 2004 GP contract, which saw doctors able to opt out of out-of-hours care, only acknowledges one small part of the wider picture. Since 2004 there has been an eight-fold increase in out of hours activity in some areas, which suggests that there are other issues that need to be addressed aside from an alteration in working hours.
The overuse of walk-in centres, which were wrongly lauded as a means of reducing pressure on A&E units, has certainly played its part in the current state of emergency care. The centres were never meant for urgent care. They were originally created for people experiencing access disadvantages, or who were without a GP, and they served this purpose very well. However, the expected immediacy of care at a walk-in centre has served to dissuade people from visiting their GP as a first step. In reality, this is not the case and has simply redistributed the primary care burden away from GP surgeries to other services.
What is interesting is that 80% of urgent care occurs between 8am and 6pm, which contradicts the health secretary's conviction that the strain on A&E services is driven by a lack of out-of-hours primary care. In addition, 90% of this activity could be within the remit of the GP. This suggests that the problem is not GP accessibility, but rather availability. GPs have acquired more and more responsibility, with a greater volume of patients to see in a shorter period of time, which has, inevitably, reduced their overall availability. The burden, and now the blame, has been placed on the shoulders of GPs, who have been soldiering on without necessary support or investment from central government.
The standard of GP premises has been frequently discussed in the press over recent months, and GPs cannot be expected to increase capacity or services without an up to date primary care estate. Many would consider it an impossible challenge to meet the needs of patients while operating from a converted terraced property, for example. Recent Care Quality Commission inspections revealed that 60% of current premises are not fit for purpose and, until the infrastructure is properly in place, primary care providers are never going to receive adequate support to deliver on their new obligations.
Ultimately, Jeremy Hunt's speech at the King's Fund leadership summit was discouraging and unhelpful for GPs across the country who have been ill-informed and operating at full capacity for a number of years. Rather than making criticisms and laying blame, he should instead analyse how to create the investment needed to support A&E departments, and allow GP surgeries to deliver the best possible service to their patients.
The lack of resources and inability to increase service provision is a disease that is blighting the NHS, both in primary and secondary care. It is time to set about treating the disease, rather than being distracted by the symptoms. Dr James Kingsland is national clinical lead for NHS clinical commissioning and Graham Roberts is CEO of Assura Group Guardian Professional.
The strained relationship between central government and healthcare professionals has come to a head, with tensions running high on both sides. The King's Fund NHS leadership and management summit brought both parties together to analyse the failings of the healthcare system, although the conclusions were not entirely impartial.
The health secretary's tactic of being critical of the primary care system in the face of accident and emergency failings is certainly a high-risk strategy.
Senior GPs are unhappy to bear the brunt of finger pointing – particularly considering the extensive reforms to the healthcare sector that they have weathered, from licence revalidation and pension difficulties to Care Quality Commission (CQC) inspections and new clinical commissioning groups. The reforms have all resulted from government policy rather than sector lobbying, so to criticise those that had no hand in creating the system seems unfair.
What has exasperated clinicians are the series of ill-informed decisions that have defined the care service over the last few years. The chaotic implementation of the non-emergency NHS 111 number demonstrated an inherent lack of understanding when it comes to patient demand. No matter how experienced the GP might be, dealing with a patient on the phone effectively is extremely difficult and makes it virtually impossible to prioritise cases properly – something that is essential if the NHS is to provide a continuity of care to its patients.
In the face of scenarios such as this, pinning all blame on the 2004 GP contract, which saw doctors able to opt out of out-of-hours care, only acknowledges one small part of the wider picture. Since 2004 there has been an eight-fold increase in out of hours activity in some areas, which suggests that there are other issues that need to be addressed aside from an alteration in working hours.
The overuse of walk-in centres, which were wrongly lauded as a means of reducing pressure on A&E units, has certainly played its part in the current state of emergency care. The centres were never meant for urgent care. They were originally created for people experiencing access disadvantages, or who were without a GP, and they served this purpose very well. However, the expected immediacy of care at a walk-in centre has served to dissuade people from visiting their GP as a first step. In reality, this is not the case and has simply redistributed the primary care burden away from GP surgeries to other services.
What is interesting is that 80% of urgent care occurs between 8am and 6pm, which contradicts the health secretary's conviction that the strain on A&E services is driven by a lack of out-of-hours primary care. In addition, 90% of this activity could be within the remit of the GP. This suggests that the problem is not GP accessibility, but rather availability. GPs have acquired more and more responsibility, with a greater volume of patients to see in a shorter period of time, which has, inevitably, reduced their overall availability. The burden, and now the blame, has been placed on the shoulders of GPs, who have been soldiering on without necessary support or investment from central government.
The standard of GP premises has been frequently discussed in the press over recent months, and GPs cannot be expected to increase capacity or services without an up to date primary care estate. Many would consider it an impossible challenge to meet the needs of patients while operating from a converted terraced property, for example. Recent Care Quality Commission inspections revealed that 60% of current premises are not fit for purpose and, until the infrastructure is properly in place, primary care providers are never going to receive adequate support to deliver on their new obligations.
Ultimately, Jeremy Hunt's speech at the King's Fund leadership summit was discouraging and unhelpful for GPs across the country who have been ill-informed and operating at full capacity for a number of years. Rather than making criticisms and laying blame, he should instead analyse how to create the investment needed to support A&E departments, and allow GP surgeries to deliver the best possible service to their patients.
The lack of resources and inability to increase service provision is a disease that is blighting the NHS, both in primary and secondary care. It is time to set about treating the disease, rather than being distracted by the symptoms. Dr James Kingsland is national clinical lead for NHS clinical commissioning and Graham Roberts is CEO of Assura Group Guardian Professional.
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