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Primary Care Recovery Plan is 'No Silver Bullet'

Plans by the Government to ease pressure on general practice in England and "tackle the 8 am rush" for appointments were described as positive steps but no "silver bullet" by GPs . 

Under the initiative, surgeries would be given new digital tools to help manage appointments, pharmacists would be funded to take more of the workload from general practice, and there would be more staff and appointments in surgeries, England's Health and Care Secretary Steve Barclay announced  this week. Outlining the challenges to the Commons, he said "patient contacts with GPs have increased between 20% and 40% since before the pandemic", whilst "the number of people in England aged 70 and above has increased by a third, and this group attends five times more GP appointments than young people".

Building Capacity

The recovery plan envisages building capacity in the system using a £385 million pot during the current financial year to employ 26,000 extra direct patient care staff with the ambition to create 50 million more appointments by March 2024 compared with 2019. Alongside that, the NHS Long term Workforce Plan, which would be "published shortly:" would include a boost to GP speciality training, encourage older GPs to stay in practice, and incentivise recently retired doctors to return to work.

An emphasis was placed on easing the early morning rush to book a GP appointment by phone. "Patients should no longer be asked to call back another

day to book an appointment, and we will invest in general practice to enable this," the document promised.

Clinically urgent cases should be assessed on the same day via a telephone or face-to-face appointment, or by the following day if the patient calls in the afternoon. Non-urgent cases assessed as needing an appointment should be scheduled within 2 weeks. 

Easing the Pressure

Although patients would be able to choose whether they wanted to access GP services by phone, in person, or online, the plan assessed that where practices had instigated online contact tools, most patients chose to contact them by this method, which shortened queues for booking by phone. As an average-sized practice could receive 100 calls in the first hour of opening on a Monday, practices which had upgraded their telephone systems from analogue to digital, capable of handling multiple calls, reported improvements in the experience of their patients. NHS England (NHSE) said it would aid the transition to digital telephony by offering financial support to procure equipment and meet training costs.

When appropriate, patients would be directed to self-care or to local services, such as community pharmacies or self-referral services. NHSE and the Department of Health and Social Care (DHSC) pledged to expand the role of community pharmacies by supporting seven further common conditions and expanding pharmacy oral contraception and blood pressure services through the 'pharmacy first' initiative. Under the scheme, scheduled for launch before the end of this year, pharmacists would be able to supply prescription-only medicines, including antibiotics and antivirals, to treat sinusitis, sore throat, earache, infected insect bites, impetigo, shingles, and uncomplicated urinary tract infections in women, without the patient needing an initial GP consultation.

The DHSC estimated that the approach, which was subject to consultation, could save up to 10 million appointments a year – the equivalent of 3% of all appointments.

Measures to cut bureaucracy would include requiring integrated care boards to report progress on improving the interface with primary care, reducing requests to GPs to verify medical evidence through increasing self-certification, and streamlining the Investment and Impact Fund from 36 to 5 indicators.

Overall, the plan would "help prevent ill health, keep cutting NHS waiting lists, and improve that vital front door to the NHS for many millions of people", Mr Barclay told MPs on Tuesday.

Turning Things Around in the Real World

Responding to the details , Professor Kamila Hawthorne, chair of the Royal College of GPs, said that "whilst all these initiatives are positive steps, none are the silver bullet that we desperately need to address the intense workload and workforce pressures GPs and their teams are working under". She said: "The only true solution is to increase numbers of fully-qualified, full-time equivalent GPs, both in the short and long terms by training and retaining them – and we look to the long-awaited NHS workforce plan with anticipation, to see how this will be achieved."

Jake Beech, policy fellow at the Health Foundation , said that with GP numbers down by almost 2000 compared with 2015 when records began, the recovery plan "falls well short of addressing the fundamental issues affecting general practice".

Beccy Baird, senior fellow at The King's Fund , commented: "With demand massively outweighing capacity, whether the proposals will be radical enough to turn things around in the real world, remains to be seen." She predicted that in the absence of a fully funded national workforce strategy, the recovery plan "will not make the much-needed improvements in access that patients and staff are hoping for".