ITV News Health Editor Emily Morgan outlines what the government's plan for GPs is, and what doctors make of it
GPs must start offering more in-person appointments, the government has said, and those who do not will be exposed in league tables.
Doctors have reacted with fury over the plan to name and shame them over access to in-person care, but the health secretary has insisted support will be provided to make face-to-face appointments more manageable.
England's chief medical officer, Professor Chris Whitty the topic of face-to-face appointments had "got rather more heat than it needs", although he suggested there could be more in-person consultations.
However, he urged GPs to effectively ignore negative press, telling delegates at the Royal College of GPs conference in Liverpool that they should "stick to the advice that is an old saying but it's completely right, which is never worry about criticism from somebody you wouldn't take advice from."
The head of the Royal College of GPs (RCGP) described the attack on medics from some politicians and sections of the media as "abuse" and said it was "demoralising and indefensible".
NHS England said measures, including a £250 million winter access fund, will enable GP practices to improve availability for in-person appointments and same-day care.
They will also see GPs freed from some red tape and other parts of the NHS will be called upon to help with some care.
Practices which fail to provide an “appropriate” level of face-to-face appointments will not be eligible for the new funding, and will be named and shamed in league tables.
Those working in the profession have slammed the plan as "ignorant" of the challenges still facing GPs due to Covid - and the wider crisis in the NHS.
British Medical Association GP committee chair Dr Richard Vautrey said: “GPs across England will be truly horrified that this is being presented as a lifeline to general practice, when in reality it could sink the ship all together."
Responding to criticism from doctors, Health Secretary Sajid Javid the government is looking at "what further support can be provided to GP practices" to assist with more in-person appointments.
He added: "What I've found already from speaking to GPs directly, not necessarily the representatives of GPs, but actually GPs that are doing the work day in, day out, is the feedback we've got has been really positive."
He insisted a role would remain for remote appointments, if patients prefer that option, but said GPs must offer in-person appointments as well.
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Why are the measures being introduced?
Following the outbreak of the Covid-19 pandemic in the UK in early 2020, social distancing measures to reduce the spread of the virus meant fewer people could sit in waiting rooms in GP practices.
In July of the same year, then health secretary Matt Hancock said that all initial GP appointments “should be teleconsultations unless there’s a compelling clinical reason not to”.
In February, before the pandemic, around 81% of GP consultations in England were in person, this dropped to below 50% in the following months, slowly rising to 54% in March this year.
Some have said that the absence of face-to-face consultations has cost them dearly.
Lizzie Molyneaux lost her 27-year-old daughter Latifah in February to an aggressive form of cancer that was misdiagnosed after numerous phone consultations with her GP.
Ms Molyneaux told ITV News she believes there's a chance her daughter may still be alive had she been seen face-to-face by her GP
But while many Covid-19 restrictions, including social distancing, have since eased, official figures show that face-to-face GP consultations are currently still only at 58%.
A new YouGov poll suggests that two-thirds of people would prefer a face-to-face appointment.
When asked which type of GP appointment they would prefer, the survey of 5,400 British adults found that 66% would prefer a face-to-face appointment, 5% would like a video consultation and 25% said they would not mind what type of appointment they would receive.
The government is hoping its new measures would help improve patient access to GPs.
Amanda Pritchard, chief executive of the NHS in England, said: “Improving access to high quality general practice is essential for our patients and for the rest of the NHS too.
“It is a personal priority and today NHS England is taking both urgent and longer term action to back GPs and their teams with additional investment and support”.
How have doctors reacted?
GPs have criticised the new package of measures, accusing the government of being “ignorant” to the scale of the crisis facing the NHS and claiming the “lack of action” will force many GPs to “hang up their stethoscopes and leave the profession for the last time”.
Doctors say the funding does not go far enough and hit out at conditions including staff shortages, high patient waiting times and abuse towards healthcare professionals.
British Medical Association GP committee chair Dr Richard Vautrey said: “It’s truly frightening that we have a government so ignorant to the needs of such a core part of the NHS.
“GPs across England will be truly horrified that this is being presented as a lifeline to general practice, when in reality it could sink the ship all together”.
He added: “It is also disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments; we need a more intelligent conversation about the variety of appointments and care that are available to patients to meet their needs”.
Health workers also said a hybrid approach to appointments will give more time for doctors to see more patients, and that returning to pre-pandemic levels of face-to-face consultations will do more harm than good.
GP Dr Raj Gill told ITV News said he'd love to see patients face-to-face, but going back to the previous model is not going to help the current situation.
GPs have said the government’s new measures fail to address the burdens placed on “a profession that is already on its knees” and do little to tackle urgent issues including staff shortages, lack of time for appointments, high levels of bureaucracy and the “torrent of abuse” workers receive daily.
The Royal College of GPs (RCGP) called on the government to fulfil its manifesto pledge of an additional 6,000 GPs and 26,000 other primary care professionals in the workforce by 2024.
Professor Martin Marshall, chair of the RCGP, said: “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”.
He added that some of the measures introduced in the government’s plans, such as increased scrutiny of GP practices by offering a text-messaging service to rate performance, will “demonise practices that are struggling”.
"We do our best, but it's never enough": GP Dr Ehsan Alkizwini told ITV News Health Editor Emily Morgan a few weeks ago that he was reaching saturation point.
Many doctors say they’ve been thrown under the bus, accusing the government of having not listened to them.
Campaign group EveryDoctor, which represents 1,700 UK doctors, said that GPs have been “blamed” for the proportion of telephone consultations offered to patients when they had been instructed by the government to offer initial consultations on the phone or online.
Dr Julia Grace Patterson, chief executive of EveryDoctor, told a briefing on Wednesday: “It’s a bit of a shock for GPs to have been told vehemently by the Health Secretary last year that all appointments should be via telephone, and now we are told the absolute opposite and, in fact, blamed for the amount of telephone consultations that have been happening”.
The group expressed concern that “inflammatory” rhetoric about access to GP services was leading to further “abuse” of staff.
Mr Javid said he recognised the pressure services across the NHS were facing due to the pandemic, but insisted areas that come under additional pressure will be given "extra support, whether it's through testing or other means".
What else is included in the blueprint?
The blueprint for improving access, published by NHS England working closely with the Department of Health and Social Care, includes a number of other measures including:
– The new investment will fund locum doctors as well as support for GPs from other health professionals such as physiotherapists and podiatrists.
– Local health systems will be given some freedom to determine how to tackle access problems, which could include “walk-in consultations”.
– But the NHS will “increase its oversight” of practices with the most acute issues in relation to access, it said.
– The money will help upgrade GP surgery telephone systems – which will hopefully drive down long waits on the phone.
– The government will reform who can provide medical evidence and certificates such as fit notes and DVLA checks – freeing up more time for appointments.
– Infection control will be assessed which could lead to social distancing in practices being changed or downgraded.
– Patients will also be able to see different types of clinicians in general practice including nurses, pharmacists and paramedics.
– The NHS will work with the Academy of Medical Royal Colleges to develop a zero-tolerance campaign on abuse of NHS staff, including GP teams.