RCGP concern over “focus on access” in blueprint for general practice in England

GP leaders have expressed concern that a focus "purely on access" in the new government blueprint for general practice in England ignores other challenges in providing high-quality, personalised care.

In the plan published by NHS England and the Department of Health and Social Care, GP surgeries are being promised additional funding to boost capacity to increase the proportion of appointments delivered face to face and "level up performance".

A £250 million winter access fund will "enable GP practices to improve availability so that patients who need care can get it, often on the same day if needed". Government says the investment will fund locums and support from other health professionals, such as pharmacists, physiotherapists and podiatrists.

The NHS England document states that every GP practice must seek patients’ input and "respect preferences for face-to-face care unless there are good clinical reasons to the contrary".

Professor Martin Marshall, Chair of the Royal College of GPs, has responded to the plan, saying: "Our hardworking members will see this package as a missed opportunity that will do little to improve the intense pressures that are preventing them from giving their patients the care they need and deserve.

"Additional financial support for patient care in general practice is always welcome, and shows the pressures facing general practice are being recognised. But a focus purely on access ignores the other challenges we face in providing high-quality, personalised care. Crucially, there is also nothing here to address the long-standing workforce pressures facing general practice."

The NHS document calls for local plans to deliver improvements in access, with practices failing to provide appropriate levels of face-to-face care being ineligible for the additional funding and “instead offered support to improve”.

The government also promises to reduce administrative burdens on GPs by reforming who can provide medical evidence and certificates such as fit notes and DVLA checks – "freeing up time for more appointments". A review of infection prevention and control (IPC) guidance will set out "practical steps" to increase the number of patients that can be seen in general practice.

To increase "oversight of practices with the most acute issues in relation to access", GP appointment data will be published at practice level by spring next year to "enhance transparency and accountability". The plans also will enable patients to use text messaging to rate their practice’s performance.

Professor Martin Marshall added: "The RCGP has always been very clear that a blend of remote and face to face consultations are necessary, and that post-pandemic this should be a shared decision between GP and patient. We know some patients prefer to see their GP face to face – but good care can and is being delivered remotely and some patients prefer it.

"Sharing some of the responsibilities for prescribing and writing fit notes will make some difference, but we need to see a system-wide programme to cut the box ticking and paperwork that fills up our days, and takes us away from frontline patient care. Reducing the burden of QOF on practices would have been a positive step forward, and we’re disappointed not to see this.

"We are particularly concerned at plans to increase the scrutiny of hard-pressed practices and the introduction of an arbitrary text message service to rate the performance of particular GP practices. There are already ways for patients to feed back on their experience – the introduction of more measures will further demoralise a profession that is already on its knees, and demonise practices that are struggling."