Primary care recovery plan – what does it mean for you and your loved ones?
NHS England has recently published its Delivery plan for recovering access to primary care. It aims to tackle some of the pressures facing GPs and other services as they work to get back to normal after the pandemic.
The British Social Attitudes Survey shows that satisfaction levels with GP teams is at an all-time low, reflecting the experiences that people are reporting to us and local Healthwatch.
The issues people tell us about:
- Having to ring at 8:00 am to try to get an appointment.
- Long times spent on hold while waiting to be put through to the reception team. This causes particular problems for people who rely on pay-as-you-go phones who can end up paying several pounds to wait in a queue.
- Only same-day appointments being available when the issue isn't urgent.
- Being unable to have a face-to-face appointment when they feel it is needed.
Even when people can get an appointment, they still face other barriers:
- Not being given a reasonable time frame for the appointment, so having to wait all day just in case the doctor rings
- Being expected to take a call when they cannot ensure privacy; for example, while they are at work
- Not being confident in using a smartphone; for example, when asked to take a photo
- On a positive note, when people do see a clinician, they are satisfied with the quality of care.
How will the plan help resolve issues in GP services?
The plan sets out two ambitions:
- To tackle the 8:00 am rush and reduce the number of people struggling to contact their practice.
- For patients to know on the day they contact their practice how their request will be managed.
The themes which underpin the plan are:
- Empowering patients
- Implementing Modern General Practice Access
- Building capacity
- Cutting bureaucracy.
Empowering patients
Under the plan, more people will benefit from both the NHS website and the NHS App that aim to help people manage their healthcare without contacting their practice directly.
NHS website
In 2023/24, the NHS website will expand information on local services and women’s health and refresh content to support new parents. It will also improve the heart age and blood pressure monitoring tools.
NHS App
90% of GP practices will offer people access to the following functions:
- to view their prospective clinical records (including test results)
- order repeat prescriptions
- see messages from their practices as an alternative to text messaging
- manage routine appointments.
From September 2023, more people will be able to self-refer for specific conditions, including:
- community musculoskeletal services
- audiology for older people, including hearing aid provision
- weight management services
- community podiatry
- wheelchair and community equipment services.
The plan also emphasises the role of Link Workers to improve use of non-clinical, community-based services.
Pharmacies to free up GPs time
The plan allows for better use of pharmacies to support people without the need to see their GP team, including a significant expansion of prescribing rights by the end of 2023 as part of Pharmacy First.
How will it work?
The extension of prescribing rights means that people will be able to get help for a broader range of conditions, including:
- sinusitis
- sore throat
- earache
- infected insect bite
- impetigo
- shingles
- uncomplicated urinary tract infections in women.
Pharmacies will also have an enhanced role in helping people manage blood pressure and ongoing oral contraception for women. NHS England will provide additional funding to support this work.
Linking pharmacy and GP records offers an opportunity to ensure that necessary information is shared quickly and efficiently.
Implementing Modern General Practice Access
The plan includes £240 million to support practices and primary care networks (PCNs) to move to digital systems and improve access to GP services. Practices need to sign up by July 2023 to benefit from this funding.
New digital systems - benefits
The main benefits relate to:
- Queuing: GP practices will manage multiple calls, patients are notified of queue position and wait time, and never get an engaged tone
- Call-back: patients have the option to be called back when they are higher in the queue
- Call-routing: patients will be directed to the right person or team (eg a medicines team serving the whole PCN)
- Integration with clinical systems: allows practice staff to quickly identify patients and find relevant information with less searching.
What will it mean in practice?
Easier access to GP practices
- Better digital phone systems will mean people will get through to their practice easier. This will be particularly useful for people who need to use mobile phone credit to make calls and who may find that cost prohibitive.
- People will no longer be tied to the 8:00 am rush.
Most urgent needs prioritised
- GP practices will prioritise people with the most urgent issues, regardless of when they contact their GP team or whether they contact them in the surgery, over the phone or online.
- This may mean that some people may need to wait a couple of weeks or so before seeing somebody. This should not be a problem for the most routine cases and will allow people with the most urgent needs to be seen sooner, without needing to call for several days when appointments are booked up because they were later in the queue.
Continuity of care
- People will be able to stay in contact with a particular clinician, as the two way messaging should provide a simple way of practices to follow-up without the need for an appointment. This will help maintain continuity of care.
- Where a follow-up appointment is necessary, this can provide a fast-track route.
- The plan will increase the use of digital triage systems where people can input details of their issues. Digital triage systems can guide them about what to do next or who they need to see. For people who are used to using digital systems, this will provide an additional way of accessing services, often more convenient.
What about people who don’t have access to the Internet?
The plan recognises the needs of people who are not confident with digital technology, those who don’t have access to the Internet and those who don’t have access to a private space for a call.
Care navigators in GP teams will be available to help people use digital systems, but practices will need to ensure that people are aware of the help available.
Where people may be less confident about using the triage system, staff will be able to enter details on their behalf.
Building capacity
To build capacity, NHS England will focus on:
- larger multidisciplinary teams
- more new doctors
- retention and return of experienced GPs
- higher priority for primary care in housing developments.
Funding
NHS England will provide up to £385 million to support Additional Roles Reimbursement Scheme (ARRS) staff such as pharmacists, care coordinators and social prescribing link workers. This will fund 26,000 staff and deliver an additional 50 million appointments by March 2024. Combined with digital access, these may provide easy access to services without involving a GP.
More doctors
The plan notes that the forthcoming workplan will include proposals for more doctors in greater detail. This includes measures to help international medical graduates, who currently represent over half of all doctors in GP training, and who may face issues with visa sponsorship licences.
NHS England will also work to enable doctors, other than GPs, to work in general practice. The plan also includes options to deal with the pensions issue that may discourage GPs from continuing to work. This runs alongside a focus on getting GPs to return to work, including in other roles, such as supporting NHS 111.
In order to increase the number of facilities – especially in new developments – leaders will look at how doctors, pharmacists, and dentists can be supported as a priority.
Cutting bureaucracy
The plan identifies two opportunities:
- improving the primary-secondary care interface
- building on the Bureaucracy Busting Concordat
Integrated Care Boards (ICBs) will need to tackle four issues in their area:
- Onward referrals
- Complete care (fit notes and discharge letters)
- Call and recall
- Clear points of contact
How will it work?
Hospitals will now be expected to make further referrals where needed and provide fit notes and discharge letters rather than send the patient back to their GP. They will also be expected to arrange appropriate follow-up care, again reducing pressure on GPs.
Hospitals will need to have a clear point of contact for primary care – such as a single outpatient email - to minimise some of the issues GPs face when making arrangements with hospitals. ICBs are expected to report progress at their meetings in October 2023.
GPs are often asked to provide letters to support medical claims – for example, for jury service or housing applications – and NHSE is looking to ensure these are only requested when strictly necessary.
Our views
Many of the improvements in the plan respond to our recommendations, based on people’s feedback.
We are reassured that the plan specifically sets out the importance of patient choice and recognises the implications:
"Our ambition is to make it easier for everyone to contact their practice however they prefer. To reduce variation, ICBs will need to focus the most intense support on PCNs and practices in the most challenging circumstances."
However, this is a challenging time for all areas of the NHS. While this plan tackles the issue of access to GPs, we are also aware that hospitals and pharmacies are also dealing with significant issues, including staffing.
The funding to support pharmacies to free up GP services will also be vital.
Additionally, some pharmacies may not be able to provide the privacy that people will need when they are seen, so there may be some challenges in implementation.
NHS England will need to consider the impact of those issues across the system before implementing the plans.
People will want to know that they can still expect the same standard of care and that they will still be able to see a GP when necessary, but that other options may enable them to be seen more quickly or at a more inconvenient time. They will also want reassurance that the different parts of the system are working with each other; for example, pharmacies and GP teams will share information where necessary.
We will keep listening and acting
We look forward to seeing the detail of the workforce plan, which will set out how the NHS will increase capacity and get the staff it requires.
Together with local Healthwatch, we will be listening to what people are saying about the implementation of the plan and how it has improved their experience. We will want to hear about what works as well as what needs improving.