The new GP plan is much better than the headlines suggest – but it’s only the beginning

It is difficult to imagine a set of headlines that would have done more to convince GPs that they are not trusted or appreciated than those which accompanied yesterday’s plan for supporting them.

These implied that the government supported a narrative of lazy doctors refusing face-to-face appointments on a whim, in dire need of a crackdown – a picture at odds with survey data of actual patient experiences, which show high satisfaction during Covid-19. There is now a risk of a spiral of increasing polarised and partisan debate playing out across tabloid headlines for weeks, undermining public confidence in general practice. All this comes at a time when patients need to feel secure they will be able to access good care when they need it, avoiding behaviours driven by fear that might mean extra demand for emergency services.

But beyond the headlines is a real issue. The system of accessing care isn’t working well for staff or for many patients. And the reality is that while ministers need to reflect on the risks of alienating the hard-working majority of GPs for a single supportive day of press coverage, there is much in the support package that is positive. 

Steps in the right direction

In fact the plan provides a potentially helpful combination of actions to address the immediate situation. There is substantial funding for an increase in capacity for acute health problems. Importantly, there is local flexibility to add that capacity in the way that fits local areas best.

Getting this right will require the regional integrated care system boards who receive the money to work with GP leaders to meet the particular needs of staff and patients. Allocating the extra funding between individual practices and the clinics or access hubs run across larger populations will need to be done carefully based on clinical need and patient preferences. It might drive inequalities if ready appointments for the worried well are inadvertently prioritised.

There will be also opportunities to bring in different types of health care professional more, and to use technology to improve capacity and access. And for more minor illnesses, using national purchasing to secure appointments with pharmacists has the potential to genuinely alleviate pressure on GPs.

The intention to collect data on variations in capacity and appointment type may have been presented in a clumsy and threatening way. But as long as it is used as a starting point for understanding the balance between what is offered, what can realistically be provided and what patients want, it creates the possibility that future policy on GP access can be informed by capacity data rather than a Daily Mail headline.

A balanced picture based on evidence will show that some practices really struggle to offer face-to-face appointments, but that others are doing what works for their patients. The evaluation of GP@Hand showed only around 13% of appointments in person, but had high satisfaction among patients, many of whom chose it specifically because of a digital-first model that was at the time the darling of government ministers.

Getting beyond one winter at a time

If anything, the problem is that a battery of winter measures is not fundamental enough. What is needed now is a much stronger policy focus on ‘getting access right’. 

This is not as simple as faster access, more convenient appointment times, or more ‘on-the-day’ appointments for patients. It is about recognising and addressing the multiple dysfunctions and inequalities that currently exist in access to primary care in England.   

One of the shifts during the pandemic has been to push all GP bookings to being ‘on the day’. But some patients simply want a routine appointment and may find it outright inconvenient to attend the same day. Those with complex ongoing health problems may get better care if they wait a bit longer to see a clinician they know who really understands their problem.

Insisting that everything happens in a single day makes it harder to keep aside immediate appointments for people with new, unexplained problems which could indicate something very serious – such as acute abdominal pain.

Secondly, many of the barriers in accessing care that patients are experiencing are not because face-to-face appointments are not available at all, but relate to problems with booking and triage. 

Practices which force all patients to submit an online consultation do not take account of individual patients’ ability to use digital services. Those which insist on telephone triage create significant challenges for patients who struggle with hearing and language. Some people really will be best able to meet their health needs by physically walking in and booking. The practice-level review proposed by NHS England must identify and look to remedy problems with access and triage at practice level.

Lastly, for the efficiency of the wider system, new capacity must be carefully designed to fit in with existing services. There is no point in adding capacity at a walk-in centre if a high proportion of patients then get sent back to their own GP to request forms for tests or referrals. 

Taking this to its logical conclusion suggests that ideally additional capacity would be delivered by local clinicians – working in their own practices or through a shared access clinic linked directly into their own medical record systems.

In the long term we need to see a focus on inclusion, personalisation and flexible routes to access care at GP practices, involving patients in identifying how to get access ‘right’.

The NHS must get better at offering each person what they individually need, and supporting GPs and their local networks to arrange their very scarce resources to manage this while also prioritising according to clinical need and severity. This is a more complex task than simply trying to return to something like the already struggling system we had two years ago.