According to the front page of yesterday’s Daily Mail, Amanda Pritchard has paid tribute to the newspaper for highlighting the ‘devastating decline in the number of people able to see their GP in person’.
If this is true, it is my view that she should pack her things into a cardboard box and do a slow walk down Whitehall.
If this is not true, she should take a wrecking ball to NHSE comm’s, for allowing this whole campaign to get out of hand.
By the way, Amanda Pritchard is the boss of NHS England… you may not know that.
Let’s look at some factoids.
The NHS Long-Term Plan calls for a ‘digital-first NHS’.
Before Covid the video-consultation pioneers, Babylon, launched and within three months had switched 80,000 patients from their original GP practice, to another, offering their service.
Pandemonium followed. Other companies entered the market. GPs were pushed into offering these services and the reimbursement mechanisms were modified to make the money work.
A huge slug of people, commuters, youngsters, worried-well and ‘up to my eyes in work’, loved the idea.
Along comes Covid.
GPs are told to close their practices to prevent the spread of Covid and were given a telephone system, called Livi, to enable remote consultations. As far as I can see Livi was ‘procured', mysteriously, under the Covid regulations without the usual open-tendering.
Social distancing regulations made it very difficult for smaller practices to operate and has been an impediment for them getting back to biz-as-usual.
As we moved away from the Covid crescendo, a bow-wave of patients, held back through Covid, hit primary care. Somehow or other the Daily Mail decided the problem was; GPs are not doing enough face-2-face consultations.
They pointed to misdiagnoses on the phone, ignoring the fact that there are misdiagnoses face to face. It happens. They're doctors, not god.
In August, GPs did 25m consults, of which 14m were face2face, 9.2m were ‘tele-med’, the rest were house-calls and allied-professionals. By the way, they also managed 1.5m vaccinations.
The £250m offered by No19 (and claimed by the newspaper as a trophy) to beef-up primary care and get more people into the surgery, is not new money. It comes from existing budgets, is the usual injection of funding GPs get every year, to employ locums and others to meet winter exacerbations and demand.
People cannot get a GP appointment, or even talk on the phone. True. That's because we have fewer GPs now than we did in 2015. Carving out some of the workload, using pharmacists and others, is the obvious route and was well under way before covid.
Locum GPs, if you can find one, may expect to earn, pro-rata, well over £100k a year, without the aggravation of being a partner or the constraints of salaried employment.
Primary care gives us +90% of first contacts for around 11% of the total NHS budget.
International comparisons are tricky because definitions of primary care vary. I can tell you we have 3 doctors per 1000, population, of which some will be GPs That puts us behind most EU countries and many across the OECD.
HMG's promise of 6k more GPs, by 2025 is fatuous. More are leaving and retiring.
Around a third of GPs work ‘part-time’, but at three days a week can still clock-up 40 hrs. Fitting-in family and other commitments, has translated into there being more female GPs than male.
Free Livi systems are likely to destroy the tele-consult market. We’ll end up with no competition and hostage to one provider.
The up-sum;
we don’t have enough GPs,
tele-consultations are NHS policy
they are popular with a huge number of people.
F2F consults are vital...
... GPs aren’t daft and can be left to make that judgement, not the Daily Mail.
Some GP tele-systems are poor but £250m injection = £30k a practice, to fund winter-pressures and staffing. It won’t touch the sides of the cost of decent, universal systems.
The facts, overwhelmingly, point to a neglected system under pressure, being bounced by a cock-eyed newspaper campaign that has ripped the agenda away from Pritchard, NHSE comms, No19 and the No10 press outfit.
They're on the back-foot because this is a failure of planning, policy, communications-strategy and most of all...
>> I'm hearing - Dame Marianne Griffiths, chief executive of University Hospitals Sussex Foundation Trust is retiring.
>> I'm hearing - Commissioners have been told to immediately begin identifying the 20% of practices in their area that are performing worst in terms of delivering face-to-face appointments. Those practices may be forced to partner with other practices.
>> I'm hearing - Jennifer Keane, the chief allied health professions officer for Northern Ireland, will be head of NHSE’s discharge and community services.
>> I'm hearing - The South West and East of England regions have seen a sharp rise in covid admissions, with the former now outstripping the much larger London region.
>> I'm hearing - CEO of East Suffolk and North Essex FT Nick Hulme has been appointed to lead the delivery of covid-19 vaccinations for people aged 12 to 15 amid sharply rising infection rates across the group. Who's going to run the Trust. Is he superfluous?
>> I'm hearing - Professor Viv Bennett has retained her position as England’s most senior public health nurse, in the wake of a major organisational shake up. She has been appointed as chief public health nurse in the newly formed Office for Health Improvement and Disparities... was it ever in doubt?
