This has been one of the toughest winters in living memory for the NHS and with spring over two weeks and 10°c away, the pressure on London GPs and their practice teams is not subsiding. We are still battling with high rates of flu and practices are juggling patients who have been shunted around by over-capacity hospitals and A&Es. If we fail to address the pressures being placed on general practice - the first line of the NHS - we risk the health of our patients and the viability of the whole NHS.
GPs, practice nurses and healthcare professionals across London and the country are consistently working harder than ever to shore up services faltering due to a lack of capacity across the system.
Keeping the show on the road is not easy. GPs across the city tell me that, as urgent care centres and A&Es reach capacity, patients are being directed to their GP and are seeking same-day appointments. A campaign with billboard adverts, targeted social media and newspaper splashes telling Londoners to contact their practice for one of 75,000 - allegedly new - extra GP appointments hasn’t helped either.
With demand for same-day appointments skyrocketing, practices are forced by circumstances to adjust their appointment systems in a way which creates unwelcome short-termism. One GP explained to me that they did not have enough free appointments to meet the requests by patients with chronic conditions and were concerned these patients’ health would deteriorate, creating even more demand.
We are also seeing hospital trusts struggling to keep up with their routine work as staff are focusing on easing winter pressures. In parts of West London hospital administration is struggling, with one practice telling me they have patients coming to get their investigation results which the GPs haven’t actually been sent. Problems like this waste patients’ time and strain the all-important relationship between them and their GP, plus the GP then has to chase up the results, wasting time that could be spent with patients.
Funding must go into frontline care; the current trend of giving seasonal gifts of cash to trusts is no substitute for sustained investment into general practice, community services and hospitals.
Chasing up on missing paperwork, seeing patients bounced over from A&E, managing conditions which should have been fixed by cancelled hospital procedures, and dealing with large numbers of essentially well people all take GPs, nurses and practice staff away from the most important (and often most rewarding) parts of their work. It’s small wonder that for the three years we’ve been surveying London practices on their workforce situation, consistently close to half of them have had a vacancy. Our December survey found that a third of GP vacancies are unfilled for more than six months and a fifth for more than 19 months.
I have real concerns that we cannot maintain a safe and accessible general practice offer whilst enduring the current pressure on our health-care services. Funding must go into frontline care; the current trend of giving seasonal gifts of cash to trusts is no substitute for sustained investment into general practice, community services and hospitals.
Whenever general practice gets extra resource it’s always split into smaller funds, pots, backs of sofas or whatever this week’s bean counting phrase is. Premises, Estates and Technology Transformation, Resilience, Vulnerable Practices are just some of these ‘funds’, all with their own application process and non-recurrent funding, when the money could simply be sent straight into frontline patient care.
If London is to maintain and sustain world-class general practice we need talented, motivated people working in it. Doctors, nurses, healthcare assistants and practice managers are more motivated when they have the time they need to care for their patients, understand their lives and apply the values of general practice. The hours of box-ticking, chasing results, pleading for referrals and grappling with regulatory red-tape need to be reigned-in if we are to retain high quality practice teams.
Yes, winter has tested us, but we need to be looking further ahead than the next morning’s surgery in order to shape our future. That’s why as leaders of the profession myself and my team at Londonwide LMCs continue to make the case for general practice wherever our values are challenged, or the interests of our patients are threatened.