Congratulations Mr Javid, you have managed to prioritise currying favour with the tabloid press over the morale of an entire profession and have managed to design a plan which will worsen the problem it should be fixing. Good work.
The new GP ‘access plan’ will make access worse, it will do this by driving even more staff out of General Practice. What’s more, it will differentially affect the healthcare of those living in the most deprived parts of the country, increasing health inequalities.
If Sajid Javid had any experience in healthcare, he may have been aware of the ‘inverse care law’. This is the phenomenon that those who are more in need of access to health care are the least likely to receive it. It is especially relevant to access to General Practice as the most in need parts of the country are the most ‘under doctored’ areas. This results in patients having the double-whammy of low doctor numbers and having to deal with the health inequity resulting from poverty, deprived environments, poor employment etc.
This new ‘plan’ misses the cause of the problem.
The root of the problem
It was never about patients not being able to access ‘face to face’ appointments specifically; although I don’t think anyone would argue that the necessity of social distancing and infection control has made the lives of health professionals and patients tough over the last 18 months (I wouldn’t recommend attempting to assess painful testicles over the phone).
No, the root of the problem we face is fairly simple; it is an absolute shortage of GPs and healthcare professionals to deal with the need in Primary Care. This is an ‘acute on chronic’ problem which means that patients have to wait, or don’t get the access they need. The problem goes well beyond arguments over face-to-face appointments; focusing on that issue is a convenient distraction away from the Government’s many years of neglect of the workforce shortage.
This new ‘plan’ looks to throw some short-term money at the problem, money which is recycled from existing budgets. Funds are apparently to be used to pay for GP locums in return for publicly naming and shaming those GP Practices holding the least proportion of face-to-face appointments. This is problematic on many levels.
Who is to know the right proportion of F2F versus telephone appointments, and by creating ‘league tables’ there are always those in the relegation zone- the ‘bottom’ 20 per cent in each area will face sanctions which will inevitably consume even more GP time to deal with them.
How better to make it more difficult to recruit and retain doctors than publicly hammering them and encouraging patients to do the same. But the consequence that should most worry a government talking about ‘levelling up’ (emphasis on ‘talking’), is that those areas that cannot recruit enough doctors to do the day job will be worse affected.
Locum GPs are harder to get hold of than HGV drivers, and many GP practices are carrying long term vacancies anyway, unable to be filled. This means the existing GPs work harder to fill the gap, burning out as they do, creating more vacancies due to sickness and exodus. A vicious spiral is created which is worse in areas with a higher burden of disease and poverty.
The ‘inverse care law’ will mean that these areas won’t be able to use this money, will be shamed locally, and the result of this will make those hanging on by their fingertips more likely to drop over the precipice of burnout. Is that really what is intended?
Those developing this plan have demonstrated that they are not in touch with what is happening on the ground in the NHS. They have shown they are more interested in a short-term cheap headline over the longer-term health of the NHS, and worst of all they have shown that they do not care about supporting underserved communities living with poor health.