SPEAKING in London last week to the British Medical Association’s conference of English Local Medical Committees (LMCs) in London, Dr Richard Vautrey, BMA GP committee chair, stressed the importance of investing in general practice ‘to ensure future sustainability of the wider NHS and the population’s health as a whole’.
Dr Vautrey’s speech also took place just a day after PM May had declared that £3.5bn from NHS long-term-plan funding would be spent on primary and community care: a pledge which he later warned ‘may make good headlines for the public . . . but must translate into real, additional and recurrent investment’.
At the same time, he commended the dedication and achievements of GPs and their practice teams despite year-round pressures, while noting areas in which progress is being made in spite of them.““
Addressing representatives of England’s 100 LMCs, Dr Vautrey said: ‘The days are shortening, the temperature is dropping, the lights are on and Christmas shoppers are packing the West End of London. All very predictable.
‘And just as predictably, NHS winter pressures are here again. But as we all know “winter pressure” is a mythical diagnosis, for we experience the reality. ‘The reality is an NHS that is in a year-round crisis – the pressure is on, 12 months of the year, day after day. We know and experience this daily pressure in our surgeries.
‘We know and experience the pressures on our patients, as they need more care from us, but we struggle with the capacity to be able to respond. And we know and experience the impact on our staff and colleagues, too many of whom are becoming ill themselves as they struggle with unsafe workloads.
‘We know the illness, but our experience has shown that short-term fixes will not solve this problem. More sticking plaster solutions will just make the patient sicker. Instead we need an effective, long-term cure. ‘We need nothing less than a properly funded NHS built on the solid bedrock of a thriving general practice.’
On the Prime Minister’s £3.5 billion announcement he said: ‘The announcement yesterday by the Prime Minister, that £3.5bn of the £20bn will be spent on primary medical and community services – with a commitment to ensure a growing share of overall NHS spending goes to general practice and community healthcare – is important for us to consider.
‘It may make good headlines for the public, but the devil will be in the detail – and as the Nuffield Trust observed yesterday “far from representing a big shift in funding towards out-of-hospital services, this money will simply allow GPs and community services to keep up with demand over the next five years – and it is not going to lead to a significant change in the way that people experience healthcare”.
‘We already have meetings scheduled in the next few days to drill down to the detail, as we cannot tolerate another five years like the last 12: and we must ensure that the crisis we face is properly addressed with real, additional and recurrent investment.
‘And to be clear, we cannot accept essential funding used for another hundred micro-schemes that wrap us up in bureaucracy, leave practices wondering where the money has gone – and patients no better off. We must see new funding used effectively, with practices in control so that we can start to address workload pressures and deliver a safer service to our patients.’
He continued: ‘You might have noticed that we’ve got a new Secretary of State for Health and Social Care. To his credit he’s listened to what we’ve said, he’s backed the partnership review and state-backed indemnity scheme work started by his predecessor, but he’s also taken repeated opportunities to underline that general practice is what the rest of the NHS is built on and depends, not least in his first party conference speech as Health Secretary.
‘He said: “Our GPs are the bedrock of the NHS. They’re everyone’s first port of call. We need more of them, better supported, and better equipped. Prevention of ill health is nothing without primary care. So, we back our nation’s GPs every step of the way…”.
‘But these words will count for nothing if they are not matched by action. They will mean nothing to the GP overwhelmed by workload pressure that is making them ill.
‘They will mean nothing to practices unable to recruit after placing advert after advert. They will mean nothing to the patient that has lost their local GP service as their practice joins the others that have closed this year.’
Focussing on Tory and Labour government policies of allowing profiteering companies roles within the NHS, Dr Vautrey continued: ‘The government has belatedly seen what was obvious to everyone else, and decided to no longer commission PFI projects because they’re not good value for money.
‘Well, perhaps they ought to learn the lessons and stop outsourcing essential NHS back-office services too, as Capita’s running of PCSE has proven to be an unmitigated disaster. ‘Practices and individual sessional GPs have had to cope with failure after failure – and whilst we’ve managed to sort out many of these problems and get some of the basic systems back on track, now we’ve seen one of their worst failings of all, with them not sending out over 40,000 invitations for smear checks: and worse, not informing women of the results, potentially leaving them at risk.
‘How bad can it get before NHS England gets its act together and sorts out a mess that they created? ‘They can outsource a service but they cannot outsource their responsibility.’ He continued: ‘GPs have been at the forefront of IT developments for decades. When it works and brings benefits we’ll run with it.
‘We’re often just limited by the lack of investment NHS England makes in basic infrastructure, such as broadband capacity and necessary software. ‘But we are also repeatedly let down, with at least seven major system failures in recent months, all too often leaving practices to pick up the pieces with little or no help being provided by NHS England or many CCGs.
‘They are all too quick to judge and blame but far too slow to step forward with support. But when technology is used as a Trojan Horse to undermine some of the core elements of British general practice, we’ll stand against it.
‘This year has seen the rise of GP at Hand, but through our lobbying and actions more and more policy makers and politicians are waking up to the damage their model of working could do to community-based general practice.
‘Most practices would want to be able to offer smartphone video consultations if they had the bandwidth to support it, as it’s probably safer than the many telephone consultations we already do. But none of us are in the business of turning away patients who are too old, or frail, or sick, or mentally ill. ‘The partnership review, ably led by LMC secretary Dr Nigel Watson, has demonstrated the importance of the partnership model – which delivers holistic continuity of care to millions of people.
‘But it’s a model of working that is supported not just by partners, but also by salaried and locum GPs too, because when working well it provides for a thriving practice that benefits everyone. But as the review has identified, and as we know all too well, this model is under serious strain.
‘We need urgent action to reduce the risks that partners are exposed to – the risks of unlimited workload pressure, of workforce management, recruitment and retention, of premises liability, of coping with unreasonable complaints and litigation, of being left to deal with GDPR and unfunded SARs requests and of course of coping with the spiralling cost of indemnity. ‘Following our lobbying, the government listened to us and commissioned the partnership review. ‘Now they must not just listen to its conclusions but take steps to act.’
