NHS NEWS: General Practice: Closures, Strikes and Wes Streeting's response

PLEASE NOTE: This transcript was AI generated and will contain errors!
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Munir Adam:
[0:06] Welcome back. It's time for another NHS News episode. Munir Adam here from Primary Care UK. Let's learn together. In these news episodes, we decide to cover current topics that are in the media that are relevant to you working in primary care. The news episodes continue to be provided by Emma and Simon. You'll remember an episode from a few months ago. And they not only bring out the selected headlines from the mainstream media, but also share how this all looks from the lens of a frontline working clinician. We know that most of patient care is provided in primary care, but what proportion of the budget does it receive? Is it close to 10%, 23% or 50%? What did the new health secretary, Wes Streeting, say after visiting a GP surgery? Which senior health figure has less than three months to produce a complex and likely influential report? Why did the G.B. practice in Cambridgeshire, like many others, end up handing back the baton and... Well, actually, that all sounds very negative, doesn't it? So why is it that despite all of that, we have some very important reasons to remain positive and to be proud of ourselves? Let's find out.

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Emma Borders:
[1:32] Right, here we are again at the Primary Care UK News Episode 2. So this is going to be heading into the autumn time and lots has been going on. So we've got some really interesting things to talk about today. I'm Emma Borders, a General Practice Nurse and Educator, and this is...

Simon Robinson:
[1:47] Hi, I'm Simon. I'm a paramedic by background, work as an advanced clinical practitioner. I'm a partner at a large PCN in Devon.

Emma Borders:
[1:55] Great. So we've got lots to talk about today, so I think you're going to kick us off, aren't you, Simon?

Simon Robinson:
[1:59] So I think there's been a lot in the news recently. Change of government, change of health secretary. We've got West Streeting coming in. This sounds like good news. I think that we all know that NHS is under huge pressure. So we talk about this quite a lot about the issues going on. Some of the news articles I've been looking at have been in the news.

Simon Robinson:
[2:18] So on the 9th of July, the first trip for the new health secretary to West Streeting, accompanied by Amanda Pritchard, who's the chief executive of NHS England. England their first trip was to a general practice group in London so it's very interesting and in one of his other articles which I'll talk about a bit in a minute he said he's deliberately done this visit to prove that he's very keen on transformation certainly within primary care the Guardian on the 8th of July reported how West Streetings pledged splins to general practice in order to fix the front door of the NHS and I think I've said before so less than 10% of the 165 billion pound budget is for general practice that's 10% of that budget considering that primary care actually does the majority of the work 93% of the work yeah

Emma Borders:
[3:09] We said that last time didn't we.

Simon Robinson:
[3:11] That it's amazing isn't it yeah

Emma Borders:
[3:13] Absolutely amazing how much work's going on in general practice.

Simon Robinson:
[3:15] Absolutely amazing. So the fact that they've identified this or he's identified this is a good point. Bringing lots of money into primary care, that's great because it's well needed, it's long overdue. It's also talking a lot about improved access and getting patients seen. So that's really interesting because it's very interesting getting patients seen and managed, but by whom? Who's going to manage these patients?

Emma Borders:
[3:41] Absolutely. I think that is one of the biggest problems. We're going to talk about the GP patient survey later. And I did flag that statistics wise, access was one of the biggest issues. But it does all come down to yeah who are the people who are going to be in these GP surgeries seeing these patients and there's already rising patient lists isn't there and demand on the GPs we do have absolutely and demand on those services so it's all well and good he's said things about bringing back the family doctor and that sounds great and it does echo the BMA sentiments and the talks that they've been having around strike action about that bringing back the family doctor and it being more that sort of feel but it is how do you do that because you do need more doctors absolutely about the family doctor so.

Simon Robinson:
[4:24] Amanda pritchard also mentioned how their plans were to bring more care outside of the hospitals into primary care this concerns me slightly because already we are doing vast workload from secondary care so is that going to come with funding again Again, staffing, who's going to staff that? And it just seems like it's going to be a lot more workload. To highlight this, there's an article in iOnline paper on the 30th of July, and it was from a patient who had been injured, stabbed in the face. He'd been to ED, and the front line headline was, it took me three weeks to get a GP appointment. Now, what actually happened, this gentleman had been to ED, veds stitch his face up and they said go and see your gp for referral to max vax right which in my view is really poor treatment uh why are they passing the buck for that referral back to primary care completely

Emma Borders:
[5:18] Unnecessary step isn't it you've just inserted absolutely for no reason.

Simon Robinson:
[5:22] Shifting workload so that that in my view is really bad the fact that that's printed shows a complete lack of understanding about primary care and as some of the colleagues often mention they're not the hospitals, SHOs, you know, there is a system in place for those direct referrals, which actually is hampering patient care, slowing down treatment processes, and, you know, it's poor practice. So my thoughts on bringing more services out of the hospital primary care, that's great, that's really good. Where's it going to be funded? Where's it going to be based? They also talk about these community neighbourhood care centres. Sounds a great idea. Brilliant. How's that going to affect PCNs and the community care? And how's that all going to link in?

Emma Borders:
[6:04] Well, yeah, so I've been wondering that as well, because is that going to replace the ICBs and the commissioning boards that we have? And then it's all going to be done at neighbourhood levels? Or, yeah, how does that fit in with what we've got now? That could be quite a radical change, couldn't it? And that might not really be very tangible. So I don't know about that. that it's a lot of posed things isn't it you think absolutely that's going to be implemented how it's going to work and we've over the last 10 years this is a problem isn't it with new governments and things although it's a positive you spend 10 years with one government shifting it one way absolutely and then maybe it is needed that we need change and i absolutely think we do and there needs more to be more funding but you then have to have all this disruption to then switch it back a different way again absolutely.

Simon Robinson:
[6:47] So they also mentioned better use of technology which i think as i may have mentioned before where i work we've been using we've got a cloud-based system we're about to have and we've been using point of care testing and we've done trials on it it'd be interesting what where thoughts are on the new tech and how that's going to actually benefit the patient and again we talk about patient access a lot which is very important but where are we going to manage them who extra are we going to manage them so i think making the right noises but mit bomb detail is needed

Emma Borders:
[7:16] With digital piece it's obviously fantastic and it's all well and good but something that i've really encountered in my training job that there's a real digital literacy problem within health care anyway so it's all well and good saying you're gonna adopt this technology or that technology but it's about having a staff and workforce that are equipped to adopt those strategies and also willing like there's quite a big pushback from a lot of this this digital technology and stuff and when it comes to AI, AI is revolutionising many sectors but not really the health service because there is such a reluctance to sort of tap into that and adopt it so that is another thing where it's like that sounds good and that could be good but how does that get implemented in reality because that will mean upskilling the workforce to become more digitally literate to be able to use these technologies. That's my concern when it comes comes to that because i i am very pro technology but how how do you do that how do you make that a reality.

Simon Robinson:
[8:15] There was um there was an also an interesting article my my neighbor who's a gp sent me on the bbc when all the records and and such went down recently with the health secretary saying yeah you may notice that your gp or your pharmacist is looking a bit more stressed than unusual but carry on and see them as normal not particularly helpful it'd be a bit more worthwhile about how we're going to fix that problem perhaps I don't know just

Emma Borders:
[8:42] Just keep showing up.

Simon Robinson:
[8:43] Absolutely the other the other point what I wanted to make on this article is that's great rediverting some of the money to primary care. That's fantastic. But actually, a lot of these hospitals are pretty cash strapped anyway. So how is it going to actually affect them? And is it going to affect waiting times or referrals? I'm not quite sure.

Emma Borders:
[9:04] Yeah, I mean, it would absolutely rely heavily on taxation, isn't it? Even though I think Keir Starmer was very reserved in trying to say that at any point during the election. But I did read some really interesting statistics that the population as a whole is quite open to taxes going up for the nhs actually in surveys that actually shows us quite popular um if it goes into the nhs to improve it because it's something that so many people are needing or their families are needing you know it's a quite a beloved thing by the public isn't it so it very well might have to be taxation and things but is that worth it.

Simon Robinson:
[9:39] Looking at the telegraph also on the 8th who report basically on the same incident but slightly slightly different angle perhaps they mentioned about the uh or they quoted about general practice team in the bedrock of the nhs which we know committed to bringing back the family doctor my question is how is that going to happen however they do acknowledge that this is going to take time to do my main concern at this report great that they've gone to general practice i mentioned gp heavy and doctors what about the rest of the workforce not a single mention to another other member of the workforce now i've yeah

Emma Borders:
[10:12] There never is.

Simon Robinson:
[10:13] No i've had a look on the uh the website of the practice they went to and to me it seems it's a 1940s doctor nurse model uh with no other health professionals seem to work there's no there's no even mention of of any other health professionals and i think that the fact that they they want to bring back so many doctors great fantastic but actually if you're using them for urgent care type of illnesses and presentations consultations it's a bit of a waste of money their skill set's more chronic yes they can do urgent care and they do it very well but actually we have other practitioners who do urgent care very well as well but there's no mention of this so actually my thoughts on this are health secretary and chief exec of nhs perhaps need to move out of london and come and have a look at the rest of the country what's happening certainly not perfect but there's some really good work happening and i think they could probably learn lots yeah

Emma Borders:
[11:05] And we've spent that goes back to that sort of changing things up again isn't it that we've spent since 2019 and those additional roles reimbursement scheme coming in and all these fantastic new professions into general practice which is fantastic if you want to shift more care and we've got different professions that can can help with that, But you've spent five years doing that and then now we're going back to the family doctor who's, you know, with no mention of anyone else. We need to sort of cultivate where we're at now with all these new professions, which has been, I think, really innovative and fantastic for general practice and a really actually positive shift. But yeah, I think there's a real lack of understanding about the staff mix in general practice just as a whole. The level of work that's going on as well by non-medical staff because we get that real frustration as general practice nurses that you're treated as someone who just takes bloods or something and you're pretty much single-handedly managing diabetes and respiratory care, chronic disease in surgeries. Some really skilled practice nurses that get no credit at all media-wise and things and recognition.

Simon Robinson:
[12:05] And a lot of the work that the chronic disease nurses do is taking work from secondary care so it's improving access for the patients to get a very high level of easy access prompt care and that's not being recognized i appreciate it's a very snap visit and it seems like they've done this for a good press release and gets the pr but i think there's a lot more to it which it wasn't said and which is slightly disappointing my favorite part of this talking about the same instant again as the health secretary wrote in for the gp online magazine if you like the cavalry is coming we're streeting and fixing the crisis of general practice let's hope it's a cavalry and not a charge of a light brigade because we don't need any more disasters do we really it's

Emma Borders:
[12:46] Really painted a picture of himself there hasn't he so yeah okay so we've got to wait for him to ride in on his horse and sabers so i mean there is a lot of positive stuff there the more funding that he is focusing some of the attention there on general practice that's all great but it's to see how that really pans out isn't it and and also something needs to happen soon really doesn't it i think,

Emma Borders:
[13:07] I mean, I've seen some really alarming things about surgeries not having the money to hire doctors. And there's a lot of newly qualified doctors who aren't able to secure posts, which I found really shocking that that was going on across the country. You know, these people are qualifying as GPs and you would think with our shortages, they would be easy, land a job, no problem. But because surgeries have such little funding, they aren't able to, which I found really surprising. I don't know if that surprised you.

Simon Robinson:
[13:35] We discussed this at work the other day and we find that hard to believe actually because we just did a quick online job search and we found multiple multiple jobs around the region right so

Emma Borders:
[13:46] You're on the same page as me because i found that really hard to believe.

Simon Robinson:
[13:49] Yeah i'm not having that at all i see the forums which i i tried to ignore whether blaming uh allied health professionals acps and physicians associates for taking over jobs that's nonsense there are plenty of gp jobs out there. What there isn't is so many locum positions which obviously attract big salaries and for a business owner being a partner, I want someone who's going to work and be committed and actually be part of a team. And ultimately, we're not having to pay so much, but we want someone who's going to be committed and part of a team who's going to be permanent. And having someone who can do the job rather than paying out of locum. So, yes, the locum market is drying up, but there's plenty of jobs out there. If you can't find one, perhaps you need to re-look at your CV and how you write it.

Emma Borders:
[14:35] I'm glad I got your opinion on that because I was really shocked when I heard that. I was like, I just can't, I can't imagine that because in my mind, it's just everyone's crying out for GPs. There's plenty of work for everyone. When people say they're stealing our jobs or whatever, there is so much work because this is a problem people have with the nursing associate role. Like it was going to steal all the nurses work you're like there's there's plenty of work there's a lot of work out there that we've got to do so we don't think we need to be fighting amongst ourselves.

Simon Robinson:
[15:00] Absolutely should we move on yeah

Emma Borders:
[15:02] Let's uh move on.

Simon Robinson:
[15:04] Okay so one of the new reports which has been commissioned is by lord darcy and some of you may remember from the last labour government this gentleman who's a surgeon by trade was used and actually created some really good reports and some really in-depth reports one of these reports actually which i used heavily when i did my msc a few years ago now was the right care right place right time report and this led to kind of greater training for allied health professionals nursing team and this made or increased the autonomy of staff to prove a better service now lord darcy's been commissioned to write a report independent investigations for NHS performance at terms of reference now this was commissioned in July with a kind of a report date of September to me NHS is a massive beast of an organisation that seems a bit fast that

Emma Borders:
[16:01] Really does how you could get a real good handle of what's going on and what the problems are and what the solutions are in a three-month period.

Simon Robinson:
[16:07] That's quite a reach isn't it however I suppose if he's been working in the NHS chess all his career he's probably got a bit of a handle on it anyway and probably knows what some of the issues are So I'm hoping it's going to be something we don't already know and be progressive and supportive to kind of drive things forward.

Emma Borders:
[16:27] So do you not know any of the touch points that he's going to cover or anything like that? It's just wait and see what happens. So next time we do our segment, we might be able to talk about what's come out in that. I mean, these reports are always good.

Simon Robinson:
[16:41] I look forward to the report.

Emma Borders:
[16:42] Yeah, absolutely. I think I think things like that are usually positive if you get people really looking at things. But it's about pretty much what we've been talking about with West Streeting is it it's good when you get these reports and they say the right things and they they identify the problems that we know to be there but then what happens you know it's about what what comes after that isn't it so watch and wait on on that one I think just following on from what we've been talking about and quite quite nicely

Emma Borders:
[17:08] from us just talking about GP jobs and things we were going to talk about GP practices shutting and that's the alarming news stories that we've been seeing around that I think that you'd seen a few local to your area?

Simon Robinson:
[17:19] There's quite a few articles actually on news articles on GP shutting. There's a couple which I kind of looked at. There's one in Nottinghamshire, report on the 16th of July, that's 4,000 patients left without a provider. And on the BBC News on the 17th of July, in Cambridgeshire, quite a deprived area of Cambridgeshire, part of Cambridgeshire, they've handed their contract back due to they report a 400% service charge hike That's going to leave 8,000 patients without a primary care provider. That's a lot of patients, certainly in a deprived area. That's quite worrying, really, isn't it?

Emma Borders:
[17:55] Yeah, that's really worrying. I mean, looking at the contract, it's quite hard to find stats on this and see how great the problem is because sometimes you can see media stories and it talks about one practice and that that's a national problem. But looking at it from how many contracts we had in 2023, there was 6,750 and now there's 6,550. So that's like a 200 different now some of those might be mergers but some of those are closures so potentially around 150 to 200 contracts have been handed back in a year and I think that's a really significant number when you think that actually we talked about patient lists a little bit earlier but patient lists are growing and demand on GPs are growing and the population is growing more work they want to happen in primary care according to the new health secretary's plan so how how is that going to work with all these practices handling in their contracts because of the conditions they're not able to keep to keep going.

Simon Robinson:
[18:50] So obviously being put my partner head on here the money we get to cover things like estates and it's not i mean we've had a tiny bit of an uplift but that majority of that money went for staff wages and i've actually had to take a drop in my takings to fund staff wages um because the money's not coming through as in the uplift is not enough and I can fully understand how some of these partnerships have just had to hand it back because it's not financially viable they're not able to pay their staff they're not able to actually pay their mortgages and it's really really quite a worrying time so some of the things I may have already mentioned we're getting lots of staff and I overheard a conversation today whilst at work since Covid times and we all know this the increase and the demand has gone sky high the amount of staff we need to employ is also needs to be higher to kind of cope with that but actually where do we put these staff we haven't got enough we've got six sites we've got loads of people coming through we've got quite a few gp registrars coming through because we like to try and invest in the future in the workforce and actually try and employ them if they're any good but where do we actually put them and one of the problems is we the money we get for notional rent and things like that has not gone up to upkeep keep these buildings and to expand these buildings.

Simon Robinson:
[20:11] Things like that it is really really tight and that that's where the model we have in primary care that that's what we need to invest in really we need to be able to pay the staff the real estates because it all that's all part of the health care and being able to provide a modern contemporary health care system yeah

Emma Borders:
[20:29] Absolutely estates is something that gets i think massively overlooked but you know you really can't do any of this stuff if you just don't have the rooms to put your clinicians in or your teams in to see these patients and do and do all these extra things that they're wanting to happen in general practice. Some surgeries are still like working out a little bungalows, are they, or whatever. I see some surgeries and I think, how are they fitting? And some of them are like rabbit warrens when you go in, but you think, how is that functioning as a GP practice? It looks like a small house. So I think, in credit to GP surgeries, they're doing a fantastic job with some really challenging estate situations, aren't they, actually? And that's a logistical nightmare for them to try and move staff around and make sure everybody's accommodated. And the knock-on effect that actually has on staff because I've worked in different surgeries and honestly having your own room that's your clinical room is such a privilege and a sort of bonus and it really massively helps your working day you know you have everything set out how you like computers all set up for you your equipment's where it needs to be and many people are having to like desk hop and move about and it's actually quite challenging just working like that so it's not something to be sort of

Emma Borders:
[21:37] taken for granted I don't think Absolutely.

Simon Robinson:
[21:39] So I think one area we just need to briefly touch on is about the proposed industrial action, if you like, which has been reported quite heavily in the papers. And I've found a couple of articles are really, really negative articles from one from Telegraph on 24th July. GPs are most entitled workers in Britain. And this very opinionated article written by someone who actually doesn't understand anything happens in primary care. And the other one on the 29th of july gps will bring the nhs to a standstill well actually looking at the bmi guidance on this issue and chatting with my colleagues things may happen may not happen yeah it's going to be not directly affecting our patients in our care um i think some of the areas which may be looked at are cutting back on making sure that our gps are managing safe numbers of patients on the day rather than having an endless list of patients and I think some of these writers of these articles don't understand that you've been in a done a 12-hour shift and then you're expected to make quick decisions on patients lives medications and other complexities it is really unsafe so I think that's potentially some of the areas what could be cut back on

Emma Borders:
[22:57] Yeah I think I think I went to a couple of BMA meetings that were about the proposed action and I actually thought a lot of what they said just made a lot of sense and it was really quite measured and sensible that like you say shouldn't impact patient care and in fact there is something about seeing a safe number of patients should just be the standard and I was talking to a student about this yesterday I was like I was saying to her the more you squeeze in you do that because you think I'm going to work really hard and I'll get it done and I'll just keep pushing myself and I won't have my break but I said it does have a knock-on effect on your patients because they don't get the quality of care they would get if you had enough time and you were able to have a proper consultation with them so I think that's really positive and one of the proposed actions as well is something you mentioned earlier so it's worth giving a nod to is that pushing back to secondary care that responsibility that these are your patients if you've seen them in A&E and you want them you know see them in A&T and have that consult then you refer them and there's this sort of inserting this unnecessary GP stepping stone and sending us their work to do like they want to start a treatment asking us to start it for them and it's a bit like well they are your patient so you know You can do that. And if we are going to do that, well, are we compensated and getting paid fairly to do that? So I think a lot of the actions are really fair.

Emma Borders:
[24:17] And measured and i think it's a misconception isn't it that you propose industrial action sounds like you're going to shut your doors and not be seeing patients and it's just not at all about that but we'll know more won't we next time we absolutely.

Simon Robinson:
[24:30] See how this pans out but

Emma Borders:
[24:32] I think we're going to end on something positive aren't we i think so the gp patient survey for 2024 which was done between january and march of this year the satisfaction survey i think they ultimately ultimately polled about 700 000 people so it's a good a good poll and it looks pretty positive doesn't it does.

Simon Robinson:
[24:50] Very very positive so one of the elements reported at nine percent of patients said their needs were met in their in their appointment whilst 92 percent said they had confidence and trust in their health care professional at the last appointment so that's interesting health care professional not just the the standard gp so that's that's really good so that's to me that's the kind of looking at the all-over care provider rather than one single trade if you like

Emma Borders:
[25:15] Yeah nearly 75 percent of people said they had a good overall experience within their gp practice which i think is fantastic of nearly 70 had a good experience about contacting their gp practice that's that's positive the ones where we don't seem to do as well on which is a sort of a little pet peeve of mine is just about access but i mean again it goes back to what you were saying about you know going to have access to healthcare professionals that are there with appointments I think we're doing as much as we can with the people that we have. So that could improve. But, The other one was 64% of people had a face-to-face appointment. And I just thought that was worthwhile mentioning because people think that we're not seeing anybody face-to-face. And actually, the vast majority of appointments there, 65% nearly, are face-to-face. So that says something as well, doesn't it, I think?

Simon Robinson:
[26:01] Yeah, and I think that we talk about face-to-face appointments and we talk about efficiencies, triage, etc. Etc some of the figures which were taken a few years ago now that where we had the everybody gets an appointment it was about 90 percent of the actual face-to-face could have been dealt with in a more efficient way so although it's good people are getting seen who need to be seen yeah i would always argue that having everyone with a face-to-face appointment is just a complete waste of resources yeah and we get back to what patients want well that's for politicians to try and win votes on not for us we're there to try and run a service to provide a good standard of care but doing what we need to do for those patients rather than wasting resources yeah

Emma Borders:
[26:46] I'd agree i think there's really innovative ways that we can work virtual consultation telephone appointments and things it's just dispelling that really common misconception that no one's been seen face to face and actually lots of people have been seen face to face.

Simon Robinson:
[26:59] Still and to be honest today i've I've been clinical today and quite a lot of patients I've been dealing with via the e-consult method have, they've been at work all day, they want to ask a question, they've got an ailment and they just want me to email or text them back and we're safe to do so. That's what I have done because they are busy people and they don't feel that they want to come in. So it's providing that advice, that treatment, that care plan via other means to fit with people's lifestyle really. So So if we didn't do a total triage system, then those appointments wouldn't be available for people who actually needed to be seen.

Emma Borders:
[27:34] Yeah, and that's it. When services are structured, we really just have to be directing that patient care to where it's most beneficial and needed the most. Probably a really nice one to end on is 89.9% of people said their needs were met at their last appointment. And I think that's the main thing, isn't it? So 90% of people are saying that they are getting what they need from those appointments. And I think that says it all, really. And that's under really, as we've talked about throughout this episode, really difficult, challenging circumstances at the minute with a real lack of funding for a prolonged period of time. People working very, very hard to make sure that people's needs are being met. And they are so well done everyone in general practice.

Simon Robinson:
[28:13] Excellent one one point i just want to mention we always remember the patients who moan and complain at us or who are rude to us on the phone or in person one point which was mentioned to me a couple of weeks ago by one of my colleagues i'm sure some people do this already if you take a post-it note and every time you manage a patient by phone or face to face and they say something positive tick it off if they say anything negative or bad then put it on another post-it note and actually what we're finding as a as a team that we the positives far far outweigh the negatives and i think that's one thing which as clinicians we need to reflect on and the vast majority of the patients we see are very pleased with what we do and how we treat them and it's unfortunately it's always the real negative ones we remember we don't actually remember the positive ones i think that's something as as a as a profession whatever trade you are within that profession that's something we need to reflect on and remember yeah

Emma Borders:
[29:15] I think that's a really great point to to close on all right well thanks and we'll we'll come back in i guess christmas we'll do a christmas episode.

Simon Robinson:
[29:25] Yeah i suppose that's the next one yeah

Emma Borders:
[29:28] That'll be when the next one is so we'll see what happens with that industrial action and the bma see if anything comes of that and we'll see what west street in actually did.

Munir Adam:
[29:37] And there we are well i hope you enjoyed these really important headlines and discussions like i did and i'm certainly looking forward to getting updates on these when emma and simon are going to provide that in a few months time meanwhile our next episode due on the 15th of september takes us to the final section of the interesting series on genomics for primary care see you then