What does the health secretary’s plan for primary care mean in practice?
In September, Thérèse Coffey became the third health and social care secretary to be appointed in 2022. She takes on the role ahead of a winter that threatens to be challenging for the NHS, with fears of high rates of COVID-19 and influenza circulating, while healthcare staff struggle to clear the patient backlog, and chronic workforce shortages continue.
Dr Coffey’s policy paper, ‘Our plan for patients’, was published on 22 September. In it, she promises to be “proactive, not prescriptive” in focusing the NHS on delivering for patients.
In this article, we look at the plans for doctors in primary care and what they mean in practice. Will they address the serious problems that GPs face?
The expectations for primary care: focus on access
Primary care teams are stretched to their limits, seeing record numbers of patients despite having fewer staff than ever. Their achievements are remarkable, but patients and the media still report difficulties in accessing appointments. Consequently, the government plans focus on access, setting expectations that:
- Everyone who needs an appointment within two weeks can get one
- Patients with urgent needs are seen on the same day
- More than one million extra appointments will be delivered over winter
- An extra 31,000 phone lines, and accelerated delivery of high-quality ‘cloud-based’ telephone solutions, will make it easier to contact practices
- From November 2022, patients will be informed about the number of appointments each GP practice delivers, and waiting times, to enable patient choice
- Integrated care boards will hold practices to account and support improved performance.
Reactions: focus on reality
These plans sound ambitious, but will they make any difference to daily practice? The British Medical Association (BMA) council chair Professor Philip Banfield commented that the plan includes “lofty ambitions and admirable principles” but “little to no concrete detail on how anything will be achieved”.
Dr Farah Jameel, chair of the BMA’s GP committee for England, also responded with scepticism as she explained that practices do not have the staff to answer more phone lines or deliver more appointments. She also noted that GPs are already delivering over a million appointments a day, so the promise of over 3 million additional appointments per year will make little difference.
In the BMJ, Professor Martin Marshall, chair of the Royal College of GPs, expressed his disappointment with the focus on access and “league tables”. He pointed out that despite the pressures, practices are already doing well in providing access: around 85% of appointments within two weeks of booking, with 44% delivered on the day.
He urged Dr Coffey to talk to the College and people who work in general practice about the real needs and expectations of patients, calling for urgent action and funding to protect general practice.
Expanding capacity in primary care
Some measures in the government’s plan are designed to expand capacity in primary care. Dr Coffey stated that funding rules would change to ‘widen the types of staff that work in general practice’. This was confirmed in a letter to GP practices about updates to the Additional Roles Reimbursement Scheme (ARRS).
Among the ARRS updates, primary care networks can now recruit GP Assistants to offer ‘clinical and administrative support’, with in-practice training by GPs. However, Professor Marshall cautioned that they must not “be seen as a solution to the chronic shortage of GPs, especially when GPs will be required to oversee their work and are ultimately responsible.”
Other plans include recruitment of more skilled staff from overseas and expanding the role of pharmacists, enabling them to manage and supply more medicines without a prescription. Although these measures may be welcome, they will not fill all the GP vacancies, so additional actions are needed.
Incentivising GPs to stay
Dr Coffey hopes to increase capacity by changing NHS pension rules, which currently disincentivise senior NHS staff, leading record numbers to take early retirement. Plans include correcting pension rules regarding inflation and encouraging other solutions, such as pension recycling.
However, few details are available and the BMA has warned that these plans do not go far enough and could make matters worse for some doctors.
The government’s plan also involves making retirement flexibilities permanent and extending temporary measures to allow experienced staff to return to, or stay in, service.
BMA guidance on safe working for GPs under pressure
GP leaders have expressed frustration that new targets are being imposed, when the workforce is under huge strain and needs a plan that will address the problems that primary care faces. Although a government plan for the workforce is in the pipeline, this has yet to be published.
In the meantime, the BMA has issued updated guidance on safe working in general practice, which urges practices to protect and prioritise core services “in order to be able to continue to deliver safe patient care, and preserve the wellbeing and health of our GPs and staff.”
If you have questions or concerns about the implications of the government’s new plan for your own practice, please contact the expert team at Medical Defense Society.
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