Colleagues
I want to send you all best wishes for the festive season. Many of you will be working in Out of Hours, Urgent Treatment Centres, Prisons, and other settings this Christmas and my thanks goes to you. Many will continue working at home to clear backlogs built up due to the increased patient demand and the recent respiratory influx. Despite this I hope that you and your teams get time to rest and recuperate after this unprecedented period of pressure.
General practices have never been so busy, with over 31 million appointments carried out in November, fifteen percent more than in November 2019, and this with fewer and fewer GPs.
ARRS colleagues are welcome in our practices, but we all know that they have not reduced our workload, which was confirmed by the National Institute for Health and Care Research in November. Fewer GPs means patients are suffering. GPs and our colleagues in general practice are doing unsafe levels of consultations. We risk making mistakes if we try to work beyond our mental and physical capacity. We will burn out and harm our own health if we continue to work in this way.
This state of affairs was brought into harsh clarity by the suicide earlier this year of Dr Gail Milligan. Dr Milligan’s death by suicide is not the first in general practice, but we must work to make it the last. To save ourselves and protect our patients we have to move to delivering safe working models. The BMA has produced guidance to help practices and we are creating more so that practices, LMCs, and ICBs can develop models which deliver for patients and keep doctors safe.
The NHS in general is at breaking point, and this is putting untold pressure on general practices. We need investment in traditional general practice. This is what patients want. This is what GPs want.
With this in mind we are soon to enter a period of negotiation for the 23/24 contract. The GPCE officer team met with senior representatives of NHS England and DHSC this week. We have agreed terms of reference for negotiations in advance of any proposed changes to the GP contract for 2023/24, and will be entering into negotiations in early January. There will likely be an accelerated process given the time available in advance of April 2023.
GPCE officers also discussed the extreme pressures being experienced by practices currently. Workforce and workload issues are such that it is increasingly difficult to maintain patient safety, and many practices have told us they are genuinely scared as to how they can continue. Some ICBs have been supportive and created local plans to support practices, but this is not universal. ICBs have been advised that to suspend QOF and IIF locally or nationally would require a level 4 national incident as these schemes are part of the statement of financial entitlement (SFE). All ICBs have now been encouraged to use local flexibilities; for example, those already within the ARRS specification to support additional workforce to provide direct patient care, suspending locally negotiated schemes whilst guaranteeing payments, and using transformation monies. There should be minimal reporting and bureaucracy involved, and the greatest imagination used as to how current schemes can support practices as quickly as possible.
That ICBs want to help their systems at this time has been welcome, but I am worried that the rigidity shown during last year’s negotiations, which led to contract imposition, will transpire again this year.
The continued negative rhetoric aimed at general practice and the rest of the NHS by politicians and some sections of the press is a dark cloud which foreshadows as we enter negotiation.
The light which gives me hope though has been the Health and Social Care Select Committee report into the Future of General Practice. This report held many helpful and useful recommendations: cessation of QOF and IIF, investment into GP premises, dealing with punitive pension taxation, supporting the partnership model, and most importantly the need to “make the job not just manageable but once again fulfilling and enjoyable”. I hope that the author of this report, Jeremy Hunt, will continue to support general practice in his new role as Chancellor of the Exchequer.
We move towards a new year with some hope. I move towards the new year with more determination to get general practice the support it needs so that GPs and practices thrive and enable them to deliver the services which patients require.
Wishing you all a safe a prosperous festive season and New Year.
Kieran
Dr Kieran Sharrock
Acting Chair, GPC England
