GPC Chair's News: 16 July 2021
Update on GPC England resolution
At the last GPC England meeting in May, the committee passed a vote of no confidence in the senior leadership of NHS England and Improvement. Among other things, the motion also instructed the GPC England executive team to cease all formal meetings with NHSEI until such time a motion could be brought back to the committee recommending that NHSEI had taken sufficient steps to restore the confidence in its leadership. This is an instruction we have followed. Yesterday, GPC England met again to discuss progress and the direction we may wish to go next.
In the eight weeks since our last meeting we have seen some positive signs and change in tone from both the Department of Health and Social Care and NHSEI, including from senior NHSEI executive directors, with public thanks and recognition of the pressures currently facing general practice, while communications have taken on a more factual tone.
But while we acknowledge and welcome these positive signs, and in particular the recognition of the important role that general practice has played throughout the pandemic as well as the pressures GPs and the whole of general practice is currently experiencing, kind words have not yet always been followed by the actions we’d like to see. In recent weeks we’ve seen flawed and overly bureaucratic enhanced services announced and activity targets introduced when the profession is on its knees. Most recently, the specifications for the Covid booster programme ignored calls from frontline GPs to be given more clinically appropriate flexibility and support in enabling practices to deliver the programme in a way that best benefited their communities.
So, despite some signs of progress, after discussion at yesterday’s meeting, a recommendation was not brought to return to formal meetings with NHSEI at this point.
We must be clear, however, that this is not a situation that we want to continue and we recognise that getting to a place where we are able to negotiate effectively on behalf of the profession with an NHSEI that clearly demonstrates that it understands and acts on the needs of general practice is in the best interests for everyone, not least our patients.
England has a new Health Secretary and in the coming weeks NHSEI will have a new chief executive, and these appointments provide an important opportunity for both the Government and NHSEI to demonstrate their clear commitment to general practice, that we hope could potentially pave the way for beginning to engage on fresh terms.
GPC England continues to discuss how we may proceed and we will keep you informed of developments in due course.
Shocking workforce crisis exposed by BMA report
The BMA published Medical staffing in England: a defining moment for doctors and patients early this week. The figures indicate that there are 1,307 (4.4%) fewer fully qualified FTE GPs than in September 2015, whilst the number of patients per GP practice is 22% higher than it was in 2015, so the GP workforce has not expanded with this rise in patient need. As a result of this, there are now just 0.46 fully qualified GPs per 1,000 patients in England - down from 0.52 in 2015.
There is an urgent retention issue with GP partners with numbers continuing to fall. It is clear that workload pressures are having a material impact as, based on the data trends, fully qualified GPs generally want to better control their workload and work-life balance. There is also a clear trend towards salaried and sessional GP roles and more portfolio and LTFT (less than full-time) working, which is the case for GP trainees as well.
The Government is clearly failing to get anywhere near its 2020 commitment of an additional 6000 doctors in general practice by 2024, as we only anticipate getting around 3,380 additional fully qualified FTE GPs (not factoring in any existing GPs reducing their hours or leaving the profession in that time). This also still falls short of the Centre for Workforce Intelligence’s 2014 prediction model of the worst-case scenario for the GP workforce in 2024.
To tackle the workforce crisis we are calling for urgent and sustained action, including:
Legislation mandating regular healthcare workforce assessments in the Health and Care Bill
Action to address workforce pressures
Reduction in bureaucracy, targets and premises pressures that particularly impact GP partners
We are also calling for an increased Treasury investment in the medical workforce, including:
Sufficient medical school, foundation programme and specialty training places
A relaxation of punitive pension taxation rules, so doctors are not forced to consider early retirement
Introduction of flexible working options for all staff
Doctor retention initiatives, as set out in our Rest, Restore, Recover (2021) report.
Read more here
Supporting general practice and latest appointment data
We all know that GPs and their teams across the country are under enormous pressures. NHS Digital has published the latest statistics for GP appointments which show that over 8.5 million vaccines appointments were delivered via general practice in England in May, on top of 23.5 million ‘regular’ appointments, again demonstrating the level of demand that practices continue to meet. These figures, taken together with the results of the national GP patient survey released last week, shows the reality of our experience, that practices are delivering hundreds of millions of appointments and as a result of our hard work the vast majority of patients are pleased with the care delivered by their general practice team.
In our letter to the former health secretary Matt Hancock, we made clear that the Government needs to do more to support general practice, not talk it down. Our message to the new Secretary of State for Health and Social Care, Sajid Javid, is the same – GPs and their staff are angry, frustrated and disappointed by this treatment. In our letter to him, we raised our concerns about the way the Government's emergency regulations have led to a command and control way of working which at times has restricted practices rather than empowered them, and asked for him to bring an end to this micromanagement of general practice from both government and NHSE/I when the restrictions are lifted on 19 July. We have also called for urgent action to reduce workload pressures through recruiting and retaining more GPs and practice nurses, and to address the premises issues that serious limit our work.
As well as our lobbying efforts, we also want to do as much as we can to support practices in England with the tools they need to explain to their patients the pressures that general practice is facing. We will be releasing more information in the coming weeks on the BMA website and in communication directly to practices.
Easing of COVID restrictions and face coverings
A BMA survey released ahead of the Government's announcement confirming the easing of the restrictions on 19 July, found that a vast majority of doctors who were asked said they were in favour of keeping rules around face coverings and social distancing.
91% of doctors surveyed believe masks should continue to be worn in healthcare settings - where practical – and 86% say the same for social care settings. 90% of those surveyed wanted to see masks remaining mandatory on public transport, and a majority thinks face coverings should continue to be worn in shops, in hospitality and workplaces, like offices.
BMA council chair Dr Chaand Nagpaul said: "Doctors are clear in their desire to protect the public’s health and our NHS by proven measures to control spread of this deadly virus. They want to see the legal requirement for wearing of face coverings retained not just in enclosed public spaces but also for patients and visitors and staff in hospitals and GP surgeries as well as social care settings."
The BMA has also co-signed a letter with the Royal Pharmaceutical Society and other stakeholders, to the Prime Minister, calling for the continued use of face masks in healthcare settings.
NHSEI have now made a statement that the government’s infection control guidance for healthcare settings has not changed, and so will continue to apply following the lifting of restrictions next week, and healthcare settings should therefore maintain face coverings among other IPC measures.
Face coverings in healthcare settings in England
While NHS England clarified that IPC guidance in GP practices would remain in place, I commented: "It is essential that this is communicated clearly and widely so that everyone understands what to expect when entering surgeries, hospitals and other health and care premises, and why these measures are necessary to protect us all and to effectively get on top of this pandemic". The story was covered in Pulse and GPOnline.
The Guardian reported that PHE made clear on Tuesday that its infection prevention control (IPC) guidance is to remain in place after 19 July, meaning the current situation on mask-wearing in health and care settings will continue. This is following pressure from the BMA and other health organisations on the government for clarity on the status of face coverings in hospitals and GP surgeries when legal requirements on mask-wearing will be lifted.
Face coverings in healthcare settings in Wales
The Welsh Government have announced that masks will remain mandatory in healthcare settings and public transport. BMA Cymru Wales welcomed the news, and David Bailey, Chair of BMA Wales, was interviewed on BBC Radio Wales (22 mins in) where he said: "We’re happy with the Welsh Government’s decision, as we’ve been calling to keep face masks mandatory in healthcare settings for a while now. We’re also pleased to see the decision extend to public transport and the reasons are very similar. You can’t ventilate terribly well, you can’t socially distance, and people who are more vulnerable to the virus don’t have any choice but to use those healthcare settings or indeed to use public transport so yes we’re very happy". He was also interviewed on ITV Wales
Face coverings in healthcare settings in Scotland
First Minister Nicola Sturgeon has said that mandatory precautions like the mandatory wearing of face coverings and guidance on ventilation and hand hygiene would remain in place "for some time" in Scotland, even following the move to level zero of Covid restrictions on 19 July.
Face coverings in healthcare settings in NI
Some rules could be relaxed on 26 July, subject to 22 July approval. From 26 July, face coverings will no longer be compulsory in places of worship or for students in school classrooms in the new term, but will remain mandatory on public transport and in shops and hospitality venues.
COVID-19 vaccination programme (England)
NHSE/I published the Enhanced Service Specification for phase 3 of the COVID-19 vaccination programme and other assorted documents yesterday.
It is very disappointing that NHSE/I are not listening sufficiently to practices and have not done more to enable local groups to safely transfer vaccines delivered to PCN sites on to member practice sites should they choose to do so. Yet at the same time we have seen vaccine safely delivered in care homes, through buses, pop-up sites and smaller pharmacies. Moreover, earlier in the pandemic vaccine has been provided to practices to deliver to their patients elsewhere in the UK. We will continue to challenge this unnecessary restriction which could lead to poorer uptake.
Local community delivery of both COVID-19 and flu vaccination is essential to the success of this programme and it's vital that local systems support practices to do this. Read our statement in response to the publication of the ES documents. This was reported by GP Online and Pulse.
I was quoted in the BMJ, and Healthcare Leader about the BMA's disappointment at NHS England's decision not to allow individual GP practices to organise and administer covid-19 vaccination boosters this autumn.
The BMA’s weekly COVID-19 data analysis is attached.
Health and Care Bill briefing for general practice
Following the introduction of the Government’s Health and Care Bill to the House of Commons last week, GPC and the BMA have produced a briefing outlining the key implications and potential impacts of the new legislation on GPs and General Practice. This covers key changes including the transfer of powers from CCGs to ICSs, GP voice within ICSs, and changes to funding flows.
Ahead of the Bill’s Second Reading this Wednesday, BMA Council also voted to express the BMA’s opposition to the Bill as presented to Parliament, arguing that it is the wrong time to be reorganising the NHS, fails to address chronic workforce shortages or to protect the NHS from further outsourcing and encroachment of large corporate companies in healthcare, and significantly dilutes public accountability. The BMA is also concerned about the wide-ranging excessive powers the Bill would confer on the Health Secretary.
Further information on the Bill and the BMA’s work this is available on a dedicated webpage.
Medical examiners roll out (England and Wales)
On Tuesday, 8 June, the UK Government formally announced the roll out of the medical examiner system into primary care in England and Wales, although medical examiners have already been in place in Scotland and in acute settings in England and Wales. Many have expressed deep concern about the impact this could have on an already overstretched, underfunded, primary care system. Complicating matters was that at the time of the announcement, there was no statutory instruments in place for the roll out.
The recently published Health and Care Bill will, if enacted, see dramatic changes for the NHS in England, and the BMA has issued a press response to the publication of the Bill, highlighting our concerns. The BMA’s Professional Fees Committee are making representations on behalf of the BMA to both the National Medical Examiner’s (NME) and the UK Government to express our concerns over the medical examiner system roll out into primary care.
Survey about CQC inspections and their effect on ethnic minority GPs
BAPIO GP forum is seeking views of GPs and GP Practices effected by CQC inspections, particularly from ethnic minority GPs or practices owned and/or led by ethnic minority GPs. This will help inform the discussions with CQC on issues facing ethnic minority GPs and the practices they work in. Please feed in your views here. If you have any questions, please contact Kalindi Tumurugoti (Kalindi.Tumurugoti@nhs.net).
GPC England meeting report
GPC England met on 15 July 2021 where much of the meeting was spent discussing what actions had been taken following the resolution from the May GPC England meeting, the results of which are outlined above. The committee also had updates on and discussed phase 3 of the COVID vaccination programme and winter flu vaccination programme, the implementation of GP Data for Planning and Research (GPDPR), and implications for primary care of the NHS Bill.
This was the last meeting of the session and several members of the committee will be leaving the committee after the BMA ARM in September. Julie-Anne Birch, Siobhan Brennan, Mark Corcoran, Lynn Hryhorskyj (Chair, GP Trainee Committee), Bob Morley, and Simon Parkinson were all thanked for their contribution and support to the committee and the profession over the years. Their wise counsel and input into our work will be missed.
This will also Fay Wilson’s last meeting as Speaker for the committee and she was thanked for the fulfilling this new role so well.
The GPC England Executive and Policy lead update is attached.
Elections for BMA’s specialist and professional committees
Voting for the Specialist and Professional Committee elections has now opened for seats on the following committees:
Private practice committee (PPC)
Professional Fees Committee (PFC)
Committee of medical managers (CMM)
The deadline for voting is 12pm Thursday 22 July 2021.
Nominations for seats on these committees have reopened until 12pm on Thursday 22 July 2021.
Civil and Public Services Committee (CPSC)
Armed Forces Committee (AFC)
Committee of medical managers (one seat)
To submit your nomination or vote, please login to the BMA’s election system. To vote or stand in the election, you must hold the relevant position for the specified seat.
If you have any queries regarding the election process, please contact firstname.lastname@example.org.
One career, endless opportunities #Choose GP
Final applications for 2021 GP specialty training will open on 27 July – 18 August 2021. Please ‘like’ and follow the #Choose GP Facebook and Instagram page to keep up to date with news and views, and forward this information to any doctors who may be thinking about career options. The GP National Recruitment Office (GPNRO) website has more guidance and we have a number of GPs and trainees who can help with enquiries. Email Daryl email@example.com to be put in touch.
Pulse reported that GPs have been threatened with legal action by patients who object to being asked to wear a face covering in their practice. Mark Sanford-Wood, GPC England Deputy Chair, said: “We have received a number of reports of practices being threatened with actions under the Equalities Act from solicitors representing people who have objected to being asked to wear a face covering to attend their surgery. It is difficult to see how such claims for financial redress could be justified under the Act and that they have the appearance of attempting to coerce GPs into breaking public health safeguards and therefore putting themselves, their staff and other patients at risk. These actions have the appearance of using the Equalities Act for a purpose for which it was clearly not intended and are a direct threat to reasonable public health measures designed to save lives.”
GPC England executive team member Krishna Kasaraneni was interviewed on Channel 4 News on a programme regarding the barriers undocumented migrants face when trying to access Covid vaccines. He said everybody is entitled to free general practice services at the point of need, regardless of immigration status.
BMA Scotland expressed concerns around the workload of GPs as growing numbers of long Covid patients add to the pressures on general practice. Patricia Moultrie, deputy chair of Scottish GPC, said: "General practices are in a very difficult place workload-wise, and we are very anxious about what the future weeks and months hold. It does look as though long Covid is going to be an illness that’s going to be managed in the community, and it’s good that fewer people are being admitted to hospital. But looking at the numbers that we’re seeing, we are very concerned about the workload that is going to be sitting in the community with the pandemic."
BMA Northern Ireland council chair Tom Black was mentioned in a piece in the Sunday Independent Ireland about the rising rates of covid infection rates in border areas. NIGPC chair Alan Stout was interviewed by Belfast Telegraph for a piece about inappropriate phone calls to under pressure GP surgeries in Northern Ireland.
Read the GP bulletin here.