The GP climate is changing. And the weather?

The new GP contract signals important changes, and we are positive about the direction.

  • Telephone consultations are integral to BMA guidance for the new enhanced service.  Sarah Montague seemed incredulous when Jeremy Hunt claimed on the Today programme that patients would be able to speak to their GP on the same day.  News for both:  our practices routinely achieve a 30 minute response.
  • Primary care is specifically linked to the wider system, all sides agreeing that rapid response will reduce pressure on A&E and emergency admissions.  The link to the Keogh review of urgent care published the same week seems almost too good to be true.  Our evidence is quoted on page 24.
  • Continuity is now explicitly valued.  Creating a dichotomy between under and over 75s is unnecessary, because the GP-patient relationship is important for all ages as we know from our research into 13,000 consultations.  But it’s on the agenda, and what we need is the method to make continuity easier whenever it matters.
  • Unalloyed good news, the 10 minute consultation rule has been abolished.  As our GPs have said for many years, the right time varies with every encounter and an efficient service means the time must be flexible.  Data from our case studies shows the average face to face consultation remains about the same length, but the range increases when GPs and patients aren’t being rushed.
  • The burden of target chasing has been reduced.  “QOF is good”.  “Less QOF is better”.  Hold those two thoughts at the same time and see if it fries your brain.  A move in the right direction but the thinking has changed little.  A new arbitrary target is for 2% of patients to go on a high risk register.  Why 2%?  In a student practice you might struggle to find enough, while on the Costa Geriatrica you’d never fit all the complex co-morbidities into 2%.
  • Online appointment booking poses a question.  If this can be for telephone appointments, our practices will have no problem as many offer this service already and it can be convenient for some.  They would not agree to booking of face to face appointments as these can be unnecessary and waste GP time, raising inequalities.  We need clarification.

What about the weather?  The daily struggle for many patients is to get an appointment.  I do wish Burnham and Hunt would stop trading insults on this – it’s a system problem, not a party political one.  The changes above mean that access and continuity for patients could become easier, but a method is needed.

The daily struggle for GPs and practices is to deal with the workload and demand. Another GP phoned me yesterday to say she was “drowning”.  The same picture applies to A&E as we are told roughly once a day.  Climate change this week may make it easier to address the issues, but there is no evidence to my knowledge that a same day telephone consultation has any beneficial effect on either GP workload or A&E demand. There is evidence that a system of rapid GP telephone response does both, and it is our vision to develop and disseminate this method so that all can benefit.

Harry Longman

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