Patient Notice: General Practice, Opening up and appointments

After a very turbulent year and some very mixed messaging in the media we wanted to write to you all with an update about general practice in Bodmin.

It’s true, General Practice has changed. In part this is due to Covid, but largely this is due to a changing general practice workforce and a change in the way the public accesses GP services.

Rising Demand

There has been a long term trend of increasing demand for general practices services and a simple increase in patient numbers. In 2008 the average no. of GP consultations per person per year was 5.5 (up from 3.9 in 1995). This data is no longer published in this format but between 2007 and 2014 overall consultation rates for GPs in England rose by 13.6% (Oxford University, 2016) and  grew again by more than 15% between 2010/11 and 2014/15 (King’s Fund, 2016).

In the last year nationally appointments numbers have increased by 18% compared to March 11% compared to March 2019.

In addition nationally the number of patients per practice is 22% higher than it was in 2015. The practice list sizes have grown from 20,487 to 23,171 In the last 4 years. But the GP workforce has not been grown with this demand. There are now just 0.46 fully qualified GPs per 1000 patients in England – down from 0.52 in 2015. In Bodmin, this number is currently 0.43 GPs per 1000 patients.

The rise in demand is complex. There has certainly been an increase in expectations from the public in terms of what a modern health system should offer to all patients and age groups. Health care has become more complex and hospital care more advanced, this has meant many aspects of what would of taken place in hospitals is now undertaken in general practice. We welcome these changes but lack the workforce to deliver them.

Until very recently things were looking very bad indeed for general practice; its funding fell from fallen from 9.6% of the NHS budget in 2005/06 to 7.9% in 2016/17 while General practice accounts for 90 per cent of all patient consultations in the NHS.

However there is some hope, the Government has started to recognise the importance of general practice as the backbone of the NHS and is investing in something called Primary Care Networks. This isn’t more money for practice’s to employ more GPs (as recruitment and availability remain an issue) but it does allow practices that group together to employ other vital roles, allowing us and many other practices to expand what we were already doing.

A Changing Workforce

So we hope you can see the need why the current changes have come about. The first big change many of you will have noticed is a change in the workforce. There are simply not enough trained GPs to run a traditional primary care system.

The practices now employ a range of clinicians who work with the GPs, under their supervision who undertake many of the traditional roles of a GP:

  • Advanced nurse practitioners
  • Clinical pharmacists and pharmacy technicians
  • Advanced physiotherapists
  • Mental health practitioners
  • Paramedics
  • Social prescribers
  • Care home nurse coordinator

This means a greater proportion of consultations must, by necessity, take place with one of these clinicians rather than the traditional GP route. In addition to this GPs must spend a greater amount of their time providing support and supervision to these roles. The relative smaller number of GPs within our teams also puts a greater proportion of the administrative burden related to clinical care on their shoulders. The net result means you are less likely to see ‘your GP’.

We want to stress that we feel this is positive change for general practice and that our patients benefit greatly from the varied experience of these different roles.

We need your support in accepting these changes to make it a success.

These changes are here to stay and will likely be increased in the future as the proportion of GPs to other clinicians reduces and so this is not something that either GPs or patients can ‘opt out’ of.

Our Appointment System

The other big change is our appointment system and how you access our services. There is a significant amount of confusion with some very mixed messages nationally.

General practice is, and always has been open, and really needs your support. The surgeries now operate what is known as a ‘total triage’ model for patient care.  This is the model of care that the NHS has asked general practice to provide. It means every clinical need of a patient is reviewed by a clinician and a plan made to meet that need.  This is to ensure that we are able to prioritise those patients who need urgent care, when and how they need to be assessed and by whom, according to their clinical need.

We no longer operate a ‘first come first served’ basis of patients booking appointments direct with reception. We need to ensure our capacity to see patients is for those who really do need a consultation in person and within a clinically appropriate timeframe.

Some people may find this very difficult, and we understand this, but we believe it is a necessary change in order to meet the increased demand we have discussed. It ensures those with the greatest need are prioritised and those who find more difficulty in accessing the service are not disadvantaged.

It has been very challenging for the practices too. We receive up to around 170 requests for assessment a day on a Monday and over 100 on the rest of the week at each practice. This is in addition to all our follow up and long term care clinics which run alongside these more urgent requests.

During the Covid outbreak we have been mandated by the NHS to operate in a different way in terms of face to face appointments. Though we have understood why this was needed we have been slowly increasing the proportion of appointments that are face to face. Space is limited in the waiting room due to social distancing measures and therefore Face to face appointments will need to continue to be based on a mutually agreed need between the patient and clinician. Our aim is to see patients face to face where the clinical issue requires physical examination.

How you can help

  • When you contact the surgery please make sure you have considered all the other options first e.g. self-remedies, NHS 111 online, your local community pharmacist.
  • Our preferred option still is for you to use our website or the NHS app to complete an eConsult message. This can be regarding either a medical or administrative issue.  This provides the greatest level of detail to help the clinicians, far more than can be provided to reception. Please use this option if you have access to it and leave the phones to those who don’t. If it is submitted before 3pm we aim to respond the same day. This does not mean that the issue will be resolved but we will assess your request and make sure that there is a clinically appropriate response. This route gives you the opportunity to access us at any time
  • If you do have to call on the phone because you have no internet access we request that you contact us before 3pm (unless your condition is something that cannot wait for the following day). Our trained reception team will ask you for further details about your health problem. Remember that your call could be one of 200 shared with us that day so the more information you can provide the better we can prioritise your problem.
  • There is cover for health issues that arise more urgently and this is provided over the whole day. Please let our trained reception team know why your need is urgent. We are not an emergency service as you know. Our team will alert the duty doctor to your urgent issue.
  • You will be triaged to the appropriate member of the team for your clinical need. As you will already be aware this team consists of GP’s, nurse practitioner, paramedics, nurses, Mental Health Practitioners and pharmacists.
  • Please don’t ask our receptionists to make a pre-booked telephone or face to face appointment with you. This is not how the current system works.
  • If you have an injury related problem then please contact 111 to be seen in the minor injuries unit. In Bodmin, as we have an MIU, the practices are not funded to provide this service, unlike in other areas, and so we have no services for this.
  • If you have an issue relating to your hospital care, please contact the hospital or specialist directly. We know this can be difficult but we don’t have the workforce to deal with their administration on their behalf.
  • Don’t believe everything you see in the media. Ask yourself about your own experience first. We know things are not perfect but we are always reviewing and evaluating our patient access and appointment system as a result of feedback.
  • We recognise that the pandemic has been exceptionally tough for our patients, but please remember it has been immensely challenging for our staff too. We thank our patients who always treat them respectfully.