Government’s ‘rescue package’ out of touch with GP crisis
After weeks of promising an ‘emergency package’ to rescue general practice, we are hugely dismayed that whilst additional funding of £250m has been promised, the Government’s so called ‘rescue package’ as a whole offers very little and shows a Government completely out of touch with the scale of the crisis on the ground.
GPs and their teams will now be facing the worst winter for decades, and as a result, patients’ care will suffer. Appointments will be harder to book, waiting times will get longer, more of the profession could leave and GPs will struggle to cope.
It is also disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments. While in-person consultations are a key feature of general practice and absolutely necessary for some patients, the pandemic has proven that in many other cases, phone or video appointments are entirely appropriate and appreciated by patients, and a crude focus on percentages or targets is completely unhelpful.
Throughout our lobbying of ministers and NHS England in recent weeks, the BMA has been clear that without a concerted effort to reduce bureaucracy, admin and red tape in practices, patient access and care was at risk.
We had four simple asks – and only increased sentencing for assaulting healthcare workers has been fully answered, but is meaningless if the Government refuses to address the crisis fuelling such abuse. The Secretary of State has started to address a second, by talking more positively about general practice at times but he needs to do much more by way of action to publicly support the profession. Sadly the tone of arrogance and dissonance within the document sends quite the opposite message, not one of thanks to the profession. I made our serious concerns about this when I meet him this week.
These proposals will only confirm the profession's belief that ministers and NHS England fail to understand the dire state of general practice – or that they, not hardworking GPs, are to blame. It is truly frightening that we have a government so ignorant to the needs of such a core part of the NHS. GPs want to improve the care we offer to our patients, but this package will not enable us to do that as we had hoped. There can be no doubt that this lack of action at such a critical time will force many GPs to hang up their stethoscopes and leave the profession for the last time.
Read my full statement
Analysis of NHSE/I package
Following our initial response to the NHSEI/government package – we have done some rapid analysis of each element of the package that shows just how many sticks there are. Our analysis shows what the package really means for general practice and highlight that it consists mainly of things NHSE/I and/or government has already stated or things that are already the case, and are clear that the few positives are completely outweighed by the impact of the negatives (often packaged as positives). We hope this will help explain just how damaging the package is and dispel any suggestion that this provides the necessary support for general practice. We have also updated our General Practice factsheet showing the facts and figures of the crisis. These are also available on the BMA website
GPC England/LMC virtual listening event 21 October 7-8pm (England)
Following recent events and the Government’s so called ‘rescue package’ for general practice published yesterday, the GPC England Executive Team will be holding a listening event via Microsoft Teams this coming Thursday 21 October from 7-8pm. We want to hear the views and ideas from LMCs around the country to help shape how GPC England responds.
There is no need to register, but please note that there is a limit of 300 people attending, so entry to the Teams meeting will be permitted on a first come first served basis.
GPCE Exec Team members are also looking to attend regional LMC events following this emergency session and will send more information about that in a separate email direct to LMCs.
We will be emailing a link to the Teams meeting early next week.
Your wellbeing
When we are working so hard to do our best for our patients, the daily torrent of abuse and vitriol directed at GPs and their teams, both in the national media and from patients and the public, is having a major impact on the morale and mental well-being of many of us. With the long awaited emergency support package failing to offer the hope needed that there will be meaningful support for the winter ahead, rather than more targets and performance management, it’s important that we our best to care for one another.
The BMA is here for you and offers supportive wellbeing services which include face-to-face counselling. You can access one-off support or, after triage, a structured course of up to six face-to-face counselling sessions. Call 0330 123 1245 today or visit the website for more information.
Workload Control in General Practice
As it is clear neither the government nor NHSEI show they understand the scale of the crisis impacting general practice, or have come forward with the necessary measures to support the profession at this critical time, we would encourage practices to look again at our Workload Control in General Practice paper. Practices should not feel pressured to return to a traditional 10 minute treadmill of face to face consultations, that are neither good for patients nor clinicians, but instead adopt arrangements that allow for longer but fewer consultations, and which delivers a higher quality of care and a safer service to our patients.
Infection control recommendations for primary care
The UK Health Security Agency today has published recommendations for changes to Infection Prevention and Control Guidance (IPC) in primary care following previous recommendations which focussed on changes in elective care.
The main amendment is the reduction of the 2 metre social distancing rule to 1 metre, highlighting the need for appropriate mitigation. The BMA has already made the point that even 1 metre social distancing will be difficult for some smaller surgeries and as such there will still have to be a reduced capacity in some practices and buildings. The guidance strongly emphasises that local decisions and local risk assessments will ultimately govern judgements such whether a face-to-face consultation is appropriate and where physical distancing can be safely reduced, which we welcome. It is therefore for practices to determine what arrangements they have in the surgery. The full guidance will be published shortly. Read more about the UKHSA review into IPC guidance
New GP workforce data
The latest GP workforce data for August show the continuing contraction of the General Practice workforce, something that the Government’s failed to acknowledge in its ‘rescue package’, although many media reports, including BBC reports yesterday, have started to helpfully focus on this important issue.
While an increase of around 1,700 GP trainees since the previous month is a positive addition, General Practice is now 1,803 fully qualified full-time equivalent (FTE) GPs short of 2015 levels. Over the past year alone General Practice has lost 380 fully qualified FTE GPs, which equates to a net loss of 307 fully qualified individual GPs (a gain of 611 salaried and locum GPs, with a loss of 918 partners).
The number of primary care nurses and direct patient care staff has also dropped over the past year, and marginal increases in the number of admin and non-clinical staff are not enough to cope with increasing administrative and bureaucratic burden.
Meanwhile, the number of patients continues to grow equating to more pressure on remaining GPs as the number of fully qualified GPs per 1,000 patients in England have fallen). This, combined with the latest GP appointment data, which showed that the total number of appointments delivered by general practice remains higher than pre-pandemic levels and the fact that appointments delivered face-to-face has risen to 57.7%, clearly illustrates that the profession is working harder than ever.
Full analysis can be found on the BMA’s Pressures in General Practice webpage.
Supporting general practice against abuse
The BMA continues to campaign against abuse of GPs and their staff with our Support Your Surgery campaign to get the changes that are so urgently needed to support general practice teams.
The latest resource added to the campaign page is a zero-tolerance poster to show that assault on practice staff, threatening or abusive behaviour or damage to property will not be tolerated.
Please continue to show your support by signing the Support Your Surgery petition to put pressure on the Government to support general practice. You can also get involved in the #SupportYourSurgery social media discussion by sharing your support across social media.
Please do all you can to help us defend and support general practice at this critical time.
Use our template letter to write to your local MP to outline the current pressures being faced by GPs across the country.
Our GP campaign factsheet can be used to rebut the misinformation in the media and to proactively include in social media posts, letters to the local press or MPs. Please share with us replies you may receive from your MP.
Joint statement condemning abuse of healthcare staff
BMA has co-signed a joint statement condemning abuse of health and care staff, together with the Academy of Medical Royal Colleges, NHS Employers, NHS Confederation, Royal College of Midwives, Royal College of Nursing and UNISON.
We ask the Government and media to 'be honest and transparent with the public about the pressures facing health and care services and that this is going to have direct implications for patients and their carers. This means making clear that the problems are systemic and that blaming and abusing individual staff members is never acceptable behaviour.'
This statement was reported in the Guardian, BusinessFast, BusinessMayor, Yahoo! and MSN. We were also mentioned in a Pulse article about a branch surgery of a Staffordshire GP practice that was forced to close down for two days last week, related to staff receiving verbal patient abuse.
Following the Guardian article BMA council chair Dr Chaand Nagpaul was interviewed on LBC.
COVID-19 Vaccinations
Local Vaccination Services SOP update
An update to the Local Vaccination Services SOP has been published, including updates relating to Phase 3, and the vaccination of eligible children and young people. It is relevant to PCN-led vaccination sites and community pharmacy-led vaccination sites participating in phases 1, 2 and / or 3 of the vaccination programme.
Light touch assurance process on third doses of Moderna for immunosuppressed patients
NHSE/I has also published a light touch assurance process on the identification and invitation by GP practices of severely immunosuppressed patients eligible for a third dose as part of their primary course of vaccination. We would encourage practices to identify and invite these vulnerable patients, by noon Friday 15 Oct. Read more here
COVID-19 Vaccination PGD and national protocol
A revised Spikevax (formerly COVID-19 vaccine Moderna) PGD and national protocol for England have now been published here
Flu vaccination guidance on accessing centrally supplied flu stock
DHSC have published guidance for general practice and community pharmacy, outlining the process for accessing centrally supplied flu vaccines for this season.
In order to achieve higher vaccine uptake rates compared to last year, DHSC has secured an additional supply of influenza vaccines, which will be for available from early November, for practices and community pharmacies to top up local supplies and where it is most needed.
Practices should determine if there is a need for further flu vaccines by assessing current uptake rates in eligible cohorts, and will be able to place orders for this stock from 18 October.
Health inequalities toolkit
The presidential project of last year’s BMA president Sir Harry Burns culminated in a health inequalities conference this week to launch the BMA’s health inequalities toolkit. The toolkit brings together ideas of projects for colleagues across the UK and across medical specialties to try, should they wish to do something to tackle the growing health inequalities felt in this country.
The toolkit is intended to support clinicians and medical students, and that the Government should take responsibility for reducing health inequalities, rather than put that responsibility on clinicians.
If you are involved in a project that seeks to address health inequalities that you would like to share with colleagues, please email info.phh@bma.org.uk to request a submission form.
PCN Clinical Director survey
Please complete our PCN survey to tell us how things are going and how the pandemic has affected your work. Your responses will provide us with insights to share among PCNs and help us negotiate with NHSE/I. It is open to all clinical directors of PCNs across England and closes on 27 October.
GPC UK election
Voting for a representative for Nottinghamshire and Derbyshire in the GPC UK election is now open.
To submit your vote please go to https://elections.bma.org.uk/
Voting will close on 25 October at midday.
You will need a BMA web account to access the election, if you do not have one you can register for access via the ‘I want temporary access to the website’ option available here. Once you register for an account you will be given an ID number which you will need to share with the elections team to enable them to give you access.
If you have any issues please contact the elections team elections@bma.org.uk
Media
Government ‘rescue package’
I was interviewed on ITV News (from 18m20s), BBC Breakfast and other BBC News bulletins, on BBC London (1:07:30 into replay), and talkRADIO (7min into the 07.00-07.30 segment).
GPC England executive team member Dr Krishna Kasaraneni was interviewed on ITV Calendar, Sky News (3.30pm), and on BBC Radios: Three Counties (4pm), Nottingham (4.08pm), Wiltshire (at 2h17m), Cambridgeshire (at 2h24m30s), Newcastle (4.30pm), Solent (at 2h40m), Humberside (at 2h46m) and Cumbria (at 2h52m45s); and on LBC (5pm).
GPC deputy chair Dr Mark Sanford-Wood appeared on Channel 5 News (5 and 6 pm), BBC Radio Dorset (7.25am), BBC Radio Hampshire (7.55am), BBC Radio Solent (at 2h25m40s) and BBC Radio Devon (at 3h10m).
GPC England exec team member Dr Farah Jameel appeared on the BBC's News at Six and News at Ten (all BBC TV channels - item at 1m30s, interview at 4m40s), and GB News last night, as well as Bloomberg radio this morning (11am).
In addition, GPC member and BMA north-west regional chair Dr Rob Barnett appeared on BBC Radio Merseyside (3h11m in replay, in a package played on BBC Radio News at Six and News at Ten (first item in the replay, Dr Barnet's interview at 2m35s), and in a TV package in the BBC's News at Six (4m into replay). North East regional council chair Dr George Rae was interviewed on BBC Radio Tees (replay at 3h43) and LBC as well as commercial radio stations in the north of England.
GP trainees committee chair Dr Euan Strachan-Orr was interviewed on BBC Radio 1 Newsbeat (12.45 pm - first item in the replay). BMA east midlands regional council deputy chair Dr Kalindi Tumurogoti on BBC Radio Leicester (7.05am), West Pennine LMC chair Dr Amir Hannan was interviewed on BBC Radio Manchester (3h10m20s into replay), and Norfolk & Waveney LMC chair Dr Tim Morton was interviewed on ITV Anglia (3m50s into replay).
The story and our views also received widespread coverage on ITV News, BBC News (Online), BBC and commercial radio news bulletins, LBC (online and on air) in the Guardian, the i, Financial Times, Daily Express (also in print), Pulse, GPOnline, and MSN. Some outlets focused on the 'league tables' of face-to-face appointments that would be published as a result of the new measures. This could be found in Sky News, the Times, Telegraph, Daily Mail, Daily Mirror, Independent, Head Topics, commercial radio stations across the country, Yorkshire Post, and Yahoo!
Many chose to cover what the plan includes and why the BMA criticised it, like the Guardian (also here, and here also both in print), ITV News, BBC News, the Telegraph, Times Radio, Medscape, the Express, Pulse (also here, here and here), Healthcare Leader, Nursing in Practice, Healthcare & Protection, Head Topics, BusinessFast, regional coverage including the Yorkshire Post (also in print) and Eastern Daily Press (also in print).
NI package of support for general practice
A statement issued by NIGPC chair Alan Stout in response to the announcement of a £5.5m support package for general practice in Northern Ireland this winter was carried across multiple news outlets: BBC News Northern Ireland, all BBC Radio Ulster news bulletins, Belfast Telegraph, Belfast Newsletter, Irish News, BelfastLive and Q Radio News. Dr Stout was also interviewed on the U105 Frank Mitchell Show about the introduction of a league table for GP practices in England and possible implications for Northern Ireland primary care. The interview was carried across yesterday’s U105 news bulletins.
Pressures in general practice
There were reports about pressures in general practice after an analysis by House of Commons
Library staff for the Liberal Democrats showed there was disparity across the country in the average number of patients per GP. In response to this I said: "These figures clearly highlight the serious pressure that is being placed upon general practice at present, as the shortage of GPs alongside a large increase in demand means that many practices are struggling." I was also interviewed on BBC Leeds about winter pressures and vaccinations.
GPC deputy chair Dr Mark Sanford-Wood was on BBC Radio Somerset (2h10m into replay), also discussing the pressures on general practice and their impact on doctors, and again on BBC Radio Somerset (1m45s), saying: "We are in the middle of a state of emergency in general practice."
The Daily Mail (also in print) and Times also reported on the health secretary's plan to reduce paperwork for GPs in order to facilitate more face to face appointments. The BMA was quoted, saying surgeries are overloaded and understaffed.
Workforce data
Sky News analysis showed the number of GPs has been decreasing while the demand is above pre-pandemic levels. In response to this, Dr Krishna Kasaraneni, said: "The shortage of GPs has both a huge impact on the remaining colleagues, whose workload increases, but crucially it has an effect on the care practices are able to offer". The Sunday Times reported on the impact of workforce shortages with a piece from a Glasgow GP quoting the BMA's calculations on the numbers of GPs per patient in the UK.
After certain sections of the media suggested the "average GP is now working a three-day week", the BMA responded to set the record straight, and highlight the workforce shortages in general practice. I said: "The very notion of a 'part-time' GP is often anything but. The data used in this article actually shows that the average hours worked by a GP in England is around 40 hours per week – the same as most full-time jobs.” I was also interviewed on Times Radio (12m30s), saying the data is a recognition that the pattern of general practice is changing, and there are huge pressures on general practice - and by the time you count 'part-time' GPs' hours, they are equivalent to what one would call full-time.
This was also covered in GPOnline, Pulse, Express Digest, the Daily Mail and Telegraph, Yahoo!, AOL and many regional outlets. There was also further coverage about the disparity in GP numbers per patients across the country, with articles in inews, the Independent, Daily Mirror, Metro, Eminetra and the Canary. And dozens of regional and local media also covered the issue looking at the numbers for their own area.
Read the GP bulletin here.
