General practice in crisis
General practice continues to face overwhelming pressures, with unmanageable workloads, coupled with a rapidly shrinking and exhausted workforce. The COVID-19 pandemic has generated a vast backlog of care, which is so far largely unmeasured and unrecognised in general practice, exerting greater pressure on a system already at breaking point.
The pressures practices are under are evident from the most recent GP appointment data which shows that in August, practices in England delivered a staggering 3 million more appointments than in the same month in 2019, meaning we are now managing the levels of demand used to see in a pre-pandemic winter in the middle of summer, fighting an uphill battle to meet patients’ needs, with fewer GPs.
It is therefore disappointing to see the announcement by the shadow health secretary last week demanding that GPs provide face-to-face appointments for every patient who wants them, making divisive headline-grabbing promises that are not grounded in reality suggesting the existing workforce are somehow not trying hard enough.
The present crisis is so acute that we now recommend practices take urgent action to preserve patient care and their own wellbeing, and have updated our guidance on Safe working in general practice, which is designed to enable practices to make decisions as to how to prioritise care, and deprioritise certain aspects of their day to day activity, within the confines of the GMS contract.
As part of this guidance, we strongly recommend practices take immediate measures to move to 15 minute appointments, move towards capping consultation numbers to a safe number per day - safe for clinicians and safe for patients. Excess demand beyond these levels should be directed to NHS 111, extended access hubs, or other providers.
Changing the way we work would allow practices to devote their resources to those patients and problems that general practice is uniquely positioned to help, and those with the greatest need, and not simply as a provider of last resort for other parts of the NHS and social care.
Practice might also want to read our guidance on How to improve the safety of your service and wellbeing of your workforce, setting out safe limits of the numbers of patient contacts per day, and what is considered ‘essential services’ under the GMS contract.
We will be looking at other ways of supporting practices - please let us know if you have any feedback on how we can develop further tools to help practices: info.gpc@bma.org.uk
| This week’s snapshot question In each LMC update we will include a question on a current issue, which will be used to help inform thoughts at GPCE and in negotiations. What would you be willing to give up in order to reduce your workload? Being part of a Primary Care Network (PCN) Seasonal vaccinations (Flu & Covid enhanced services) Quality and Outcomes Framework (QoF) Investment and Income Fund (IFF) Routine vaccinations Please answer here |
Mental health and wellbeing
We are all affected in different ways by the increasing workload and pressures faced each day in practices, with many of us feeling exhausted and drained at the end of a day in surgery. If our wellbeing is suffering, we cannot care for our patients as well as we would like, if we are in need of care ourselves. We, as doctors, have to start prioritising our wellbeing so that we can continue to provide the care to patients that they need.
It is World Mental Health Awareness Day on Monday 10 October. The day is dedicated to raising awareness of mental health and the theme of the day this year is to 'make mental health and wellbeing for all a global priority’. We encourage anybody who is feeling under strain to seek support, and also check in on your colleagues’ wellbeing. We also encourage practices who could not participate on 9 September to reflect and focus on their wellbeing, to consider identifying another time when they could meet as a practice to focus on wellbeing and how to reduce workload.
A range of wellbeing and support services are available to doctors, from the BMA’s 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Visit the BMA’s dedicated wellbeing support services page for further information and resources.
For all other support, speak to a BMA adviser on 0300 123 1233 or email support@bma.org.uk. We encourage you to access any, or all, of the forms of support mentioned above, and encourage colleagues to do so too if you are ever struggling.
PCN DES opt out window
As practices may be aware, at the end of September NHS England published a letter outlining support for practices and PCNs. This includes changes to the ARRS (including changes to reimbursement rates to reflect the Agenda for Change pay award and the introduction of ‘GP Assistants’ and ‘PCN Digital Leads’), removal/postponement of some IIF indicators, and a new PCN ‘capacity and access support payment’, funded from the reduced IIF indicators.
As these changes have been introduced by NHSE in-year, an opt-out window for the PCN DES has been triggered. Within this opt-out window, practices can choose to opt-out of the DES without risking a breach of contract. We have developed this guidance as a primer to support practices that are considering opting out of the DES.
We would advise practices to read the guidance and consult with their staff and fellow PCN members as to whether to utilise the window to leave their PCN. If practices choose to stay in their PCN, the next op-out window is expected to be April 2023.
Survey on how inflation and energy costs are impacting your practice
We know GP practices across England are feeling the impact of inflation and high energy costs. Please complete our survey so that we can collect the evidence we need to advocate on your behalf. The survey asks for a range of information relating to practice costs including energy, staffing and other expenses.
It may be that your practice manager is best placed to complete the survey, and while we would encourage you to complete the whole survey, if you do not yet have the information, please still complete the parts you can. We need to hear from as many practices as possible to enable us to make a strong case to NHSE/I, DHSC and the government to seek solutions. Take the short survey here (closing Thursday 20 October).
Citizen access to records programme
Following representations made to NHS England, GPC England has not received satisfactory assurance that the citizen access to records programme scheduled to rollout on 1 November can go ahead. Against a backdrop of sky-high pressures on general practice, the necessary planning and resourcing required to launch the programme at this time cannot be put in place to enable a safe and successful rollout. We are supportive of the initiative to enable patients to view their medical records but this cannot be rushed. We remain open to discussions with NHS England about how best to facilitate a delay to the programme.
Updated flu specification
NHSE/I has published an updated flu specification, alongside updated guidance, which now covers vaccination of practice staff. Whilst this will ensure that flu vaccinations provided to staff will be covered under the CNSGP, please be aware, however, that practice staff vaccination will still not be eligible for an IoS (Item of Service) payment or vaccine reimbursement for this year. We recognise this is a frustrating decision and will continue to press NHS England about this issue and try to reach a better solution for many practices out there who are already facing enormous pressure as we head into the winter months.
NHSE vaccination strategy consultation
As you may be aware NHS England (NHSE) is seeking engagement from providers to inform the future shape of vaccination services and share views on ways in which NHSE can maximise uptake of vaccinations and reduce inequalities.
The original ‘market engagement exercise’ closes at midnight, 7 October, however, as part of the same process NHSE have also published an alternative consultation page on the proposed ‘strategy’, which remains open to the 13 October. If practices or LMCs still wish to contribute, you can do so via either method using the links below:
For more information on this exercise, the Future NHS page here provides a copy of the draft vision, the feedback questions, a portal user guide and FAQs.
It remains our view that general practice remains the best route to engaging with patients and encouraging vaccine uptake across all GP based V&I programmes, and that any expansion of providers runs the risk of simply redistributing existing patients and undermining practice funding patients, rather than increasing uptake. We have subsequently made clear to NHSE that the key to meeting the aims of its strategy is to build upon and support existing practice based programmes.
We will continue to engage with NHSE on their proposals and update as things progress.
Proposed repeal of the IR35 tax reforms
As part of the recent ‘mini-budget’ the government announced that it intends to repeal the 2017 and 2021 IR35 reforms of the IR35 off-payroll working rule. The changes are expected to come into force from April 2023 and, once confirmed, the BMA will produce further guidance in due course.
Best Practice Show, 12-13 October 2022, NEC Birmingham
The BMA and GPC England will have a dedicated theatre at the at Best Practice Show at the NEC Birmingham on 12-13 October 2022. The programme focusses on the most pressing issues facing general practice, including the future of general practice, working within ICSs, workload management, workforce management and primary care estates.
Free for healthcare professionals, the conference programme will provide up to 12 hours of CPD certified training, expertly tailored to meet the training requirements of healthcare professionals.
If you are interested in attending, you can register here.
GP Committee elections
Nominations will open at 12pm on Tuesday 11 October for a by-election for the below seats to the GPs (GPC) in the following regions:
Please note that in previous years there was a requirement that only GPs who paid the voluntary levy could nominate themselves for election. That requirement has now been removed.
To submit your nomination for any of the above seats please visit https://elections.bma.org.uk/ (the deadline is 12pm Tuesday 25 October 2022). You must be a BMA member to stand in this election.
For any questions relating to the role or GPC please contact info.gpc@bma.org.uk
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Music video - A tribute to the NHS
We have been contacted by Dr Alex Watson, a GP in Ashtead and Leatherhead in Surrey, who wanted to share a song that he wrote earlier this year called ‘Change’ about the impact of the COVID pandemic. It is intended to be a tribute to the NHS and all those health and care workers who lost their lives. The final production can be seen via this link: https://youtu.be/lVwDKAK8OVo
