NHS NEWS: General Practice: Closures, Strikes and Wes Streeting's response | Primary Care UK:...

hey guys check out our new podcast do your clinics tend to run late do you feel frustrated by inefficient systems at work that make no sense or being given work that you shouldn't even be doing I'm Monir Adam a working gpn educator I am acutely familiar with the clinician's struggle the clinician Survival Guide is about helping you get more in your life as a clinician and helping you find practical solutions to the challenges that you face every Tuesday in under 15 minutes I dissect a topic of interest and explore potential Solutions the clinician's survival guide is the free and convenient way for your journey to becoming more productive better rewarded and happier so subscribe now and make the [Music] change welcome back it's time for another NHS news episode morning Adam here from primary care UK let's learn together in these news episodes we decide to cover current topics that are in the media that are relevant to you working in Primary Care the news episodes continue to be provided by Emma and Simon you'll remember an episode from a few months ago and they not only bring out the selected headlines from the mainstream media but also share how this all looks from the lens of a Frontline working clinician we know that most of patient cases provided in primary care but What proportion of the budget does it receive is it close to 10% 23% or 50% % what did the new health secretary West streeing say after visiting AGP surgery which senior health figure has less than 3 months to produce a complex and likely influential report why did the GB practice in citer like many others end up handing back the Baton and well actually that all sounds very negative doesn't it so why is it that despite all of that we have some very important reasons to remain positive and to be proud of ourselves let's find [Music] [Music] out right here we are again at the primary kuk news episode 2 so this is going to be heading into the Autumn time and lots has been going on so we've got some really interesting things to talk about today I'm Emma borders a general practice nurse and educ and this is hi I'm Simon I'm a paramedic by background work as an advanced clinical practitioner I'm a partner at a large PCN in Devon great so got lots to talk about today so I think you're going to kick us off aren't you Simon so I think there's been a lot of the news recently change of government change of Health secretary we've got West streeting coming in it sounds like good news I think that we all know that NHS is under huge pressures we we talk about this quite a lot about the issues going on some of the news articles I've been looking at been in the news so on the 9th of July the first trip for the new health secretary West streeting accompanied by Amanda Pritchard who's the chief executive of NHS England their first trip was to a general Practice Group in London so it's very interesting and in one of his other articles which I'll talk about bit in a minute he said he's deliberately done this visit to prove that he's very keen on transformation certainly within Primary Care the guardian on the 8th of July reported how West streets pledged bans to general Practice in order to fix the front door of the NHS and I think I've said before so less than 10% of the 165 billion budget is for general practice that's 10% of that budget considering that Primary Care actually does majority of the work 93% of the work yeah we said that last time didn't we that it's amazing isn't it yeah absolutely amazing how much work's going on in sh practice absolutely amazing so the fact that they've identified this or he's identified this H is is is a good point bringing lots of money into primary care that's great because it's it's well needed it's long overdue it's also talking a lot about improved access and getting patients seen so that that's really interesting because it's very interesting getting patients seen and managed but by whom who who's going to manage these patients absolutely I think that is one of the biggest problem we're going to talk about the GP patient survey later and I did flag that statistics wise access was one of the biggest issues but it does all come down to yeah who are the people who are going to be in these GP surgeries seeing these patients and there's already Rising patient lists isn't there in demand on the GPS we do have absolutely and demand on those services so it's all well and good he's said things about bringing back the family doctor and that sounds great and it does Echo the BMA sentiments and the talks that they've been having around strike action about that bringing back the family doctor and being more that sort of feel but it is how do you do that CU you do need more doctors Absolut about the family doctor so Amanda Pritchard also mentioned how their plans were to bring more care outside of the hospitals into Primary Care This concerns me slightly because already we are doing vast workload from secondary care so is that going to come with funding again Staffing who's going to staff that and uh it just seems like it's going to be a lot more more workload to highlight this there's an article in I online paper on the 30th of July and it it was from a patient who had been injured stabbed in the face he'd been to Ed and the front line headline was it took me three weeks to get a GP appointment now what had actually happened this gentleman had been to Ed fed stitched his face up and said go and see a GP for refer to maxfax right which in my view is really poor treatment uh why are they pass in the buck for that referral back to Primary Care completely unnecessary step isn't it you just inserted for no reason shifting workload so that that in my view is really bad the fact that that's printed shows a complete lack of understanding about primary care and as some colleagues often mention they're not the hospitals shos you know there is a system in place for those direct referrals which actually hampering patient care slowing down treatment processes and you know just poor practice my thoughts on bringing more services out of Hospital primary care that's that's great that's really good where's it going to be funded where is it going to be based they also talk about these Community neighborhood Care Centers sounds a great idea brilliant how's that going to affect pcns uh and the community care and how's that all going to link in well yeah so I've been wondering that as well because is that going to replace the icbs and the commissioning boards that we have and then it's all going to be done at neighborhood levels or yeah how does that fit in with what we've got now that could be quite a radical change couldn't it and that might not really be very tangible so I I don't know about that it's a lot of Po things isn't it you think I how that's going to be implemented how it's going to work and we've over the last 10 years this is a problem isn't it with new governments and things although it's a positive you spend 10 years with one government shifting it one way absolutely and then maybe is needed that we need change and I absolutely think we do and there needs more to be more funding but you then have to have all this disruption to then switch it back a different way again absolutely so they also mentioned better use of technology which I think as I may have mentioned before where where I were with been using we've got a cloud-based uh system we're about to have we've been using point of care testing and we've done trials on it it'd be interesting what where thoughts are on the new tech on how that's going to actually benefit the patient and again we talk about patient access a lot which is very important but where are we going to manage them who extra we going to manage them so I think making the right noises but mbor is needed well with digital piece it's it's obviously fantastic it's all well and good but something that I've really encountered in my training job that there's a real digital literacy problem within Healthcare anyway absolutely so it's all well and good saying you're going to adopt this technology or that technology but it's about having a staff and Workforce that are equipped to adopt those strategies and also willing like there's quite a big push back from a lot of this digital technology and stuff and when it comes to ai ai is revolutionizing many sectors but not really the Health Service uh because there is such a reluctance to sort of tap into that and adopt it so that is another thing where it's like that sounds good and that could be good but how does that get implemented in reality because that will mean upskilling the workforce to become more digitally literate to be able to use these technologies that that's my concern when it comes comes to that cuz I I am very Pro technology but how how do you do that how do you make that a reality there was um there was an also an interesting article my my neighbor who's a GP sent me on the BBC when all the the records and and and such went down recently with the health secretary saying yeah you may notice that your GP or your pharmacist is looking a bit more stressed than usual uh but carry on and see them as normal not particularly helpful um it'd be a bit more worthwhile about how we're gonna fix that problem perhaps I don't know just just keep showing up absolutely the other the other point what I wanted to make on this article is that's um great re red diverting some of the money to primary care that's fantastic but actually a lot of these hospitals are pretty cash strapped anyway so how is it going to actually affect them and is it going to affect waiting times or referrals not quite sure yeah I mean it would absolutely rely heavily on taxation isn't it even though I think K dama was very reserved in trying to say that at any point during the election but I did read some really interesting statistics that the the population as a whole is quite open to taxes going up for the NHS actually in surveys that actually shows us quite popular um if it goes into the NHS to improve it because it's something that so many people are needing or their families are needing you know it's quite a beloved Thing by the public isn't it so it very well might have to be Taxation and and things but is that worth it looking at the telegraph also the eight for who report basically on the same incident but slightly different angle perhaps they mentioned about the uh or they quoted about general practice team in the Bedrock of the NHS which we know committed to bringing back the family doctor my question is how is that going to happen however they do acknowledge that this is going to take time to do my main concern at this report great that they've gone to general practice I mentioned GP heavy and doctors what about the rest of the workforce not a single mention to another member of the workforce now I've yeah there never is no I've had a look on the the website of the practice they went to and to me it seems it's a very 1940s doctor nurse model uh with no other health professionals seem to work there's there's no even mention of of any other health professionals and I think that the fact that they they want to bring back so many doctors great fantastic but actually if you're using them for Urgent Care type of illnesses and presentations it's a bit of a waste of money their skill sets more chronic yes they can do Urgent Care and they do it very well but actually we have other practitioners who do Urgent Care very well as well but there's no mention of this so actually my thoughts on this are Health secretary and chief exec of NHS perhaps need to move out of London and come and have a look at the rest of the country what's happening certainly not perfect but there's some really good work happening and I think they could probably learn lot yeah and we've spent that goes back to that sort of changing things up again isn't it that we've spent since 2019 and there's additional roles reimbursement scheme coming in and all these fantastic new professions into general practice which is fantastic if you want to shift more care and we've got different professions that can can help with that but you've spent 5 years doing that and then now we're going back to the Family Doctor Who's you know with no mention of anyone else we need to sort of cultivate where we're at now with all these new professions which has been I think really Innovative and fantastic for general practice and a really actually positive shift but yeah I think there's a real lack of understanding about the staff mix in general practice just as a whole the level of work that's going on as well by non-medical staff because we get that real frustration general practice nurse that you treat someone who just takes Bloods or something and you're pretty much single-handedly managing diabetes and Respiratory Care chronic disease in in surgeries um some really skilled practice nurses that get no credit at all media wise and and things and recognition and a lot of the work that the chronic disease nurses do is taking work from secondary care um so it's improving access for the patients to get a very high level of easy access prompt care and that's not being recognized I I appreciate it's a very snap visit and it seems like they've done this for a good press release and get some PR but I think there's a lot more to it which it wasn't said and which is slightly disappointing my favorite part of of this talking about the same instant again is uh the health secretary wrote in for the GP online magazine if you like the Cavalry is coming West Street s fixing the crisis of general practice let's hope it's a Cavalry and not a charge of a Light Brigade because uh we don't need any more disasters dowie really he's really painted a picture of himself there hasn't he so yeah okay so we got to wait for him to ride in on his horse and Sabers so I mean there is a lot of positive stuff there the more funding that he is focusing some of the attention there on general practice that's all great but it's to see how that really pans out isn't it and and also something needs to happen soon really doesn't it I think I I mean I've seen some really alarming things about surgeries not having the money to hire doctors and there's a lot of newly qualified doctors who aren't able to secure Pur which I found really shocking that that was going on across the country you know these people are qualifying as GPS and you would think with our shortages they would be easy land a job no problem but because surgeries have such little funding they they aren't able to which I found really surprising I don't know if that surprised you we discussed this at work the other day and um we find it hard to believe actually because we just did a quick online job search and we found multiple multiple jobs around the region right so you're on the same page as me cuz I found that really hard to be yeah I'm not having that at all I see the forums I I try to ignore where they're blaming uh Allied health professionals acps and and physan Associates for taking all the jobs that's nonsense there are plenty of GP jobs out there what there isn't is so many loc positions which obviously attract big salaries and for a business owner being a partner I want someone who's going to work and be committed and actually be part of a team and ultimately we're not having to pay so much but we want someone who's going to be committed and part of a team who's going to be permanent and having someone who can do the job rather than paying out on locom so yes the loc Market is drying up but there's plenty of jobs out there if you can't find one perhaps you need to relook at your CV and uh how you write it I'm glad I got your opinion on that because I was really shocked when I heard that and I was like I just can't I can't imagine that cuz in my mind there just everyone's crying out for GPS there's plenty of work for everyone when people say there stealing our jobs or whatever there is so much work because this is a problem people have with the nursing associate role like it was going to steal all the nurses work you like this there's plenty of work a lot there's a lot of work out there that we've got to do so we don't think we need to be fighting amongst ourselves absolutely should we move on yeah let's uh move on okay so one of the new reports which has been commissioned is by Lord Dary and some of you may remember from the last Labor government this gentleman who's a surgeon by trade was used and actually created some really good reports and some really in-depth reports one of his reports actually which I used heavily when I did my MSC a few years ago now was the uh right care right place right time report and this led to kind of Greater training for Allied health professionals nursing team and this made or increased the autonomy of staff to prove a better service now Lord dar's been commissioned to write aort report independent investigations for NHS performance a terms of reference now this was commissioned in July with a kind of a report date of September to me NHS is a massive Beast of an organization that seems a bit fast that really does how you could get a real good handle of what's going on and what the problems are and what the solutions are in a three-month period that's quite a reach isn't it however I suppose if he's been working in the HS all his career he's probably got a bit of a handle on it anyway and probably knows what what some of the issues are so I'm hoping it's going to be something we don't already know and be Progressive and supportive to kind of Drive things forward so do we not know any of that the touch points that he's going to cover or anything like that it's just wait and see what happens so next time we do our segment we might be able to talk about what's come out in that I mean these reports are always good I look forward to uh the report yeah absolutely I think I think things that are usually positive if you get people really looking at things but it's about pretty much what we've been talking about with West trting is it it's it's good when you get these reports and they say the right things and they they identify the problems that we know to be there but then what happens you know it's about what what comes after that isn't it so watch and wait on on that one I think just following on from what we've been talking about and quite quite nicely from us just talking about GP jobs and things we're going to talk about uh GP practices shutting and that's the alarming uh news stories that we've been seeing around that I think you'd seen a few local to your area there there's quite a few articles actually on on on news articles on GP chatting there's a couple which I kind of looked at there's one in noing Shire report on the 16th of July that's 4,000 patients left without a provider and on the BBC news on the 17th of July in cambrid quite a quite a deprived area of CER part of CER they've handed their contract back due to they report a 400% service charge hike and that's going to leave 8,000 patients without a primary care provider that's that's that's a lot of patients and certainly in a deprived area that's it's quite worrying really isn't it yeah that's that's that's really worrying I mean looking at the contract it's quite hard to find stats on this and see how great the the the problem is sometimes you can see media stories and it talks about one practice and you know that that's a national problem but looking at it from how many contracts we had in 2023 there was 6,750 and now there's 6,000 550 so that's like a 200 different now some of those might be mergers but some of those are closures so potentially around 150 to 200 contracts have been handed back in a year and I think that's a really significant number when you think that actually we talked about patient lists a little bit earlier but patient lists are growing and demand on GPS are growing and the population is growing more work they want to happen in Primary Care according to the new health secretary's plan so how how is that going to work with all these practices handling in their contracts because of the conditions they're not able to to keep going so obviously being put my partner head on here the money we get to cover things like States and it's not I mean we've had a tiny bit of an uplift but that majority of that money went for staff wages and I've actually had to take a drop in my takings to fund staff wages um because the money's not coming through as in the uplift is is not enough and I can fully understand how some of these Partnerships have have just had to hand it back because it's not financially viable they're not able to pay their staff they're not able to actually pay their mortgages and it's it's really really quite a worrying time so some of the things I may have already mentioned we getting lots of staff and I I overheard a conversation today whilst at work since covid times and we all know this the increase and the demand has gone Skyhigh the amount of staff we need to employ is also needs to be higher to kind of cope with that but actually where do we put these staff we haven't got enough we've got six sites we've got loads of people coming through we've got quite a few GP regist coming through because we like to try and invest in the future and the workforce and actually try and employ them if they're any good but where do we actually put them and one of the problems is we the money we get for notional rent and things like that has not gone up to upkeep these buildings and to to expand these buildings so things like that it is really really tight and that that's where the model we have in primary care that that's what we need to invest in really we need to be able to pay the staff for real estates because all it's all part of the healthare and being able to provide a a modern contemporary Health Care System yeah absolutely estate is something that gets I think massively overlooked but you know you really can't do any of this stuff if you just don't have the rooms to put your clinicians in or your teams in to see these patients and do and do all these extra things that they're wanting to happen in general practice some surgeries are still like working out a little Bungalows are they or whatever and I see some Sur and I think how are they fit in and some of them are like rabbit Warren when you go in but you think how have that functioning as a GP practice it looks like a small house so I think in in credit to GP surgeries they're doing a fantastic job with some really challenging estate situations aren they actually and that's a logistical nightmare for them to try and move staff around and and make sure everybody's accommodated and and the knock on effect that actually has on staff because I've worked in different surgeries honestly having your own room that's your clinical room is such a a privilege and a sort of bonus and it and it really massively helps your working day you know you have everything set out how you like computer's all set up for you your equipment is where it needs to be and many people are having to like desk cop and move about and it's actually quite challenging just working like that so it's not something to be sort of taken for granted I don't think absolutely um so I think one area we just need to briefly touch on is about the proposed industrial action if you like which it's been reported quite heavily in the papers and I've found a couple of Articles really really negative articles from one from Telegraph from 24th of July GPS are most entitled workers in Britain and this very opinionated article written by someone who actually doesn't understand anything happens in Primary Care uh and we have one on the 29th of July GPS will bring the NHS to a standstill well actually looking at the BMI guidance on this issue and chatting with my colleagues things may happen may not happen going to be not directly affecting our patients and our care um I think some of the areas which may be looked at are cutting back on making sure that our GPS are managing safe numbers of patients on the day rather than having a endless list of of patience and I think some of these writers of these articles don't understand that you've been in done a 12-hour shift and then you expected to make quick decisions on patients lives medications and other complexities it is really unsafe so I think that's potentially some of the areas what could be cut back on yeah I think I think I went to a couple of BMA meetings that were about the proposed action and I actually thought a lot of what they said just made a lot of sense and it was really quite measured and sensible that like you say shouldn't impact uh patient care and in fact there is something about seeing a safe number of patients should just be the standard and I was talking to a student about this yesterday I was I was saying to her the more you squeeze in you do that CU you think I'm going to work really hard and I'll get it done and I'll just keep pushing myself and I won't have my breakes but I said it does have a knocker effect on your patients because they don't get the quality of care they would get if you had enough time and you were able to have a proper consultation with them so I think that's really positive and one of the proposed actions as well is something you mentioned earlier so it's worth giving a nod to is that pushing back to secondary care that responsibility that these are your patients if you've seen them in A&E and you want them you know see them in ENT and have that consult then you refer them and there's this sort of inserting this unnecessary GP stepping stone and sending us their work to do like they want to start a treatment asking us to start it for them and it's a bit like well they are your patient so you know you can do that and if we are going to do that well are we compensated and getting paid fairly to do that so I think a lot of the actions are really fair and measured and I think it's a misconception isn't it that you proposed industrial action sounds like you're going to shut your doors and not be seeing patients and it's just not at all about that but we'll know more won't we next time we absolutely see how this pans out but I think we're going to end on something positive aren we um I think so the GP patient survey for 2024 which was done between January and March of this year the satisfaction survey I think they ultimately pulled about 700,000 people so it's a good a good poll and it looks pretty positive doesn't it it does very very positive so one of the elements reported that 90% of patients said their needs were met in their in their appointment whil as 92% said they had confidence and Trust in their healthc care professional at the last appointment so that's interesting Healthcare professional not just the the standard GP so that's that's really good so that's to me that's the kind of looking at the all over care provider I've one single trade if you like yeah nearly 75% of people said they had a good overall experience within their GP practice which I think is fan Fantastic of nearly 70% had a good experience about contacting their GP practice that's that's positive the ones where we don't seem to do aswell on which is a sort of a little pet peeve of mine is just about access but I mean again it goes back to what you were saying about you know got to have access to healthcare professionals that are there with appointments I think we're doing as much as we can with the people that we have so that could improve Pro but the other one was 64% of people had a face to- face appointment and I just thought that was worthwhile mentioning cuz people think that we're not seeing anybody face to face and actually the vast majority of appointments there 65% nearly are face to face so that's says something as well doesn't it I think yeah and and I think that we talk about face Toof face appointments and and we talk about efficiencies triage Etc some some of the figures which were taken a few years ago now that where we had Fe everybody gets an appointment it was about 90% of the actual face Toof face could have been dealt with in a more efficient way so although it's good people getting seen who need to be seen I would always argue that having everyone with a face Toof face appointment is just a complete waste of resources yeah um and we get back to what patients want well that's for politicians to try and win votes and not for us we're there to try and run a service to provide a good standard of care but doing what we need to do for those patients rather than uh wasting resources yeah I I'd agree I think there's really innovative ways that we can work virtual consultation telephone appointments and things it's just dispelling that really common misconception that no one's been seen face to face and actually lots of people have been seen face to face still and to be honest today I've had I've been clinical today and quite a lot of patients I've been dealing with VI the E consult method have been at work all day they want to ask a question they've got an ailment and they just want me to email or text them back and we safy so that's what I have done because they are busy people and they don't feel that they want to come in so it's providing that advice that treatment that care plan via other other means um to to fit with people's lifestyle really so if we didn't do a total triage system then those appointments wouldn't be available for people who actually needed to be seen yeah and that's it is when when Services structure we really just have to be directing that patient care to to where it's it's most beneficial and needed the most probably a really nice one to end on is 89.9% of people said their needs were met at their last appointment and I think that's the main thing isn't it so 90% of people are saying that they are getting what they need from those appointments and I think that says it all really and that's under really as we've talked about throughout this episode really difficult challenging circumstances at the minute with with a real lack of funding for a prolonged period of time people working very very hard to make sure that people's needs are being met and they are so well done everyone in general practice excellent one one point I just want to mention we always remember the patients who moan and complain at us or who are rud to us on the phone or in person one point which was mentioned to me a couple of weeks ago by one of my colleagues I'm sure some people do this already if you take a Post-It note and every time you manage a patient by phone or face to face and they say something positive tick it off if they say anything negative or bad then put it on another Post-It note and actually what we're finding as a as a team that we the positives far far outweigh the negatives and I think that's one thing which as clinicians we need to reflect on uh the vast majority of the patients we see are are very pleased with what we do and and and how we treat them and it's unfortunately it's always the real negative ones we remember we don't actually remember the positive ones and I think that's something as as a as a profession whatever trade you are within that profession that's something we need to reflect on and remember yeah I think that's a really great point to to close on all right well thanks and we'll we'll come back in I guess Christmas we'll do a Christmas episode yeah I suppose that's the next one yeah that'll be when the next one is so we'll see what happens with that industrial action and the BMA see if anything comes of that and we'll see what West Street in actually did and there we are well I hope you enjoyed these really important headlines and discussions like I did and I'm certainly looking forward to getting updates on these when Emma and Simon are going to provide that in a few months time meanwhile our next episode due on the 15th of September takes us to the final section of the interesting series on genomics for Primary Care see you then okay three important messages first we believe that podcasting should be interactive you may have ments you wish to make about something you've heard you may have something to contribute after all we don't know it all or you may have a question you wish to ask us and you can do that by joining our Primary Care community group on LinkedIn and a link to that is provided in the show notes second do tell your friends and colleagues about the podcast and leave positive ratings and comments on Apple Spotify or wherever you can the reason for that is because positive ratings and increased downloads attract sponsorship from professional organizations and allows us to avoid putting in those intrusive ads that are so of often found in podcasts and finally if you do wish to sponsor us or get involved in contributing to episodes you can get in touch with us on our website primary care.org but that's it for today until next time keep well and keep safe [Music] [Music] Primary Care UK was developed by therapeutic Reflections limited to inform educate support and unite the primary care Workforce specifically it is not for the general public or patients all information and advice contained therein is time location and context dependent and is general advice only no guarantees are provided with respect to the accuracy of the content the hosts contributors and the organizations they represent do not accept liability for any actions consequences or effect that result directly or indirectly from the content provided please refer to the abso description for more information thank you for listening [Music] [Applause] [Music]