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GPC suggest 15 minute appointments

General Practice is under tremendous pressure, affecting GPs, patients’ and the wider health care economy. With an ageing population many patients often attend for GP consultations with multiple and complex health issues, which often results in consultation times that are no longer adequately timed to address every concern. Compounding these issues, is a rising public expectation that all appointment times must be adhered to with no delays to the patient. Patients often expect not to have to return to another consultation and would much prefer all issues addressed and corrected in one tidy, concise consultation. GPs who show visible signs of exhaustion, frustration or who are not able to achieve or manage their workloads leave themselves vulnerable to complaints, verbal abuse and, in some instances, physical assault and therefore all work must be completed with a smile on one’s face.

Introduce low recruitment and retention figures into the mix and the situation and workload imbalances really begin to become evident. Yet, given the nature of future health needs, never have primary care services been so important to the success and sustainability of the NHS. Why then, do financial resources not match the level of importance the government places on primary care? With a constant stream of promises from the government for more money and more staff, not now obviously but in years to come, it has never been as important to explore the supply, demand and capacity issues crippling many GP surgeries. We need to work smarter, more efficiently and ensure workloads are delivered in the right place, at the right time by the right and most appropriately trained healthcare professional. With government action proving too little too late, the GPC along with many GP leaders have made their own recommendations that they believe will prevent primary care from imploding upon itself.

In a bid to reduce workloads and solve the recruitment crisis, the actions suggested by the GPC, which are outlined in the ‘Urgent Prescription for General Practice Campaign’, include these key areas:

  • ‘Fair and sustainable funding and resources to reach a minimum of 11% of NHS spend to cover the work of general practice and resolve the funding deficit of around £2.5bn.
  • Reducing workload to ensure delivery of safe and high-quality care with a national standard for a maximum number of patients that GPs, nurses and other primary care professionals can reasonably deal with within a working day, and greater clarity about what work is appropriate to be delivered by practices.
  • Ensure GPs and other practice team members are enabled to routinely offer 15 minute consultations or longer where necessary for patients with greater needs such as complex or multiple morbidity.
  • An expanded and demarcated workforce, both within and around the practice so that non-essential GP work can be completed by other healthcare professionals.
  • Reducing the regulatory burden of the CQC, to prevent time and resource being taken away from service provision. Reducing bureaucracy and duplication, to empower professionals and to give more time to meet the needs of patients.
  • Reducing bureaucracy and duplication, to empower professionals and to give more time to meet the needs of patients.
  • Empowering patients to give them confidence to manage their care and to free up GPs’ time for those who need it most.
  • Infrastructure and technology to deliver practice and system resilience to ensure practices are able to deliver the services needed’.

Placing optimism to one side, it will be interesting to see what similarities, if any, there are to Jeremy Hunt’s ‘GP Roadmap’ – the rescue package for GP’s and for Primary Pare. Will this just end in another distraction, creating more tiers of bureaucracy and debate, as a result of unachievable goals or generate suggestions for improvement that just don’t quite get to the heart of the issues at hand?

More pressure is needed from GPs and other Primary Care leaders to ensure that action means action.

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NHS 111 Chokes A+E

NHS 111 which was meant to offer help to patients and direct them away from emergency services has come under fire in recent months by both Government and Senior Clinicians, about its effectiveness at performing this function.

As the latest data released by NHS England shows, of all calls triaged by NHS 111, a staggering 12% had ambulances dispatched, while a further 8% were referred to A&E. Of note, 62% were recommended to primary care, 4% were recommended to another service and only 14% were managed directly by the service. The figures for further referral represent the highest ever recorded since the service first began in 2010.

The service is currently facing criticism on many fronts with many of its referrals being regarded as inappropriate and therefore placing unnecessary pressure on frontline services.
Is this the service, or is this a product of the system as a whole, which is widely regarded as inefficient and cost ineffective?
This criticism is also being fuelled by the fact that the majority of the workforce do not have a Nursing or Medical background, and therefore lack the necessary knowledge and skills to triage appropriately, without recourse to an automated rigid computer algorithm.

There is a growing body of evidence suggesting that many patients are being inappropriately referred on to A&E because of issues arising in primary care. For example, at the peak call times for NHS 111, there are a significant number of calls for urgent repeat prescriptions. These patients are then booked into out of hour appointment slots as the call handler cannot triage the urgency of the missing medications. This blocks OOH slots which would be better utilised by GPs assessing patients with higher medical acuity.  Instead, appointments are full and because of the risk adverse nature of the 111 service, patients are referred on to A&E.

With a public perception of lack of appointments and inadequate services in primary care, there is growing pressure on GPs to provide leadership on improvement and change within the NHS.