Dr Kanan Pande and the team at Wolseley Medical Centre in Hull appeared on BBC Look North on 9th June 2021 in a report illustrating the pressures facing general practice.
The visit was set up by the LMC to help explain to the public why practices are so busy, and how clinicians and support staff are working on their behalf. Journalist Anne-Marie Tasker spoke to GPs, admin staff and patients in a report which highlighted the scale of the workload facing Doctors and practice staff.
Clips from the report can be viewed via this Twitter thread. You can also view them on our Facebook page.
Well done to Dr Pande & team at @WolseleyMedical who on BBC Look North last week showed the reality of the pressures #generalpractice is under.— Humberside LMC (@HumbersideLMC) June 15, 2021
"The phones are non-stop from eight o'clock in the morning..." pic.twitter.com/OonkD0tOKV
"We are now dealing with three times as much work as we did previously and we ask for some understanding," Dr Pande says. "We will see everybody who needs to be seen, it might just mean that you don't get your appointment today. However anyone who needs urgent help is clearly being seen."
Congratulations to Dr Pande and the team at Wolseley Medical Centre for giving up time in such a busy period to highlight the role of general practice.
Humber, Coast and Vale ICS have published a presentation which gives an overview of the transition to the new NHS body - NHS Humber, Coast and Vale - from April 2022.
It outlines how HCV will, subject to legislation, discharge its responsibilities through Place based and Sector based units of operation (Place Partnerships and Provider Collaboratives). It describes how Place Partnerships will operate and sets out proposed arrangements for funding will work.
The LMC continues to receive queries from practices about the contractual position around online consultations. Along with other LMCs, we have sought clarification from the GPC England team. While NHS England refers to online consultations in the latest SOP dated 4th May, the contractual position has been outlined by the BMA - see LMC UK conference | COVID vaccination | online consultations – contractual requirements (bma-mail.org.uk) (scroll down to the Online consultations – contractual requirements heading). This is an extract from the GPC advice:
The contractual position
Before the pandemic, as part of the 2019 GP contract deal paragraph 5.10 (i)) GPC England agreed that it would eventually become contractual for practices to offer online consultations during core hours. This agreement has not yet been added to the contract regulations, so is not currently a contractual requirement. However, GPCE also agreed that practices should offer online consultations as early as possible, provided that the necessary infrastructure is in place, but it would not become a requirement until it is entered into the contract regulations. It is therefore for practices to determine how best they use online consultation systems, including what hours they are available, and they should try to use them in such a way that helps with triage and workload management, enabling the delivery of a safer and more accessible service to all their patients.
The LMC wishes to reassure practices that they are under no contractual obligation to provide access to any online consulting platforms outside their core contracted hours of 8am-6:30pm (or 6pm if local arrangements are in place), Monday to Friday. We know that some practices find online platforms useful, however where a practice feels they are not helpful in the delivery of their services, or they are not yet fully ready for their implementation they may request that the provider deactivates them outside core hours or completely. Where deactivating these platforms is technically difficult (e.g. from the provider end), practices may wish to simply remove the link on their website as a temporary measure – you do not need to seek permission to do so but should inform the CCG so they are aware. Please feel free to copy the LMC in if you wish.
With thanks to BBO LMC for sharing their statement on this matter.
The latest edition of our regular monthly newsletter is now available, containing all the latest updates and opportunities for general practice in the Humber area. Included in this month's issue:
- Onlince consultations - our advice to practices
- Humberside LMC Leadership Programme for GPs from BAME backgrounds
- CQC update from recent LMC liaison meeting
Download the LMC Newsletter May 2021.
“If I die, it will be your fault,” is just one of the abusive comments heard by GP reception staff, as a new survey* launched today shows 75% report experiencing daily abuse from patients.
With the majority (78%) facing threatening behaviour, racist or sexist abuse from patients, and 83% reporting having called the police for help, today the Institute of General Practice Management (IGPM) launch their campaign to end all abuse towards general practice staff.
The IGPM members have responded to the increase in physical, verbal, and written abuse towards practice staff over the Covid-19 pandemic, with a video of real-life examples of patient interactions from practices across the UK. These include:
- GP staff whose tyres were slashed by a patient who had not been able to get an appointment that day;
- A receptionist with Chinese heritage, who received racist abuse and was spat on in relation to the Covid-19 virus;
- Daily verbal threats including the common phrase: “If I die, it will be your fault”.
Robyn Clark, a practice manager in South Gloucestershire and one of the founders of the IGPM commented: “As demand for GP services has increased dramatically over the last year, sadly so has the amount of abuse practice staff have faced.
“The aim of our campaign is to highlight the good work practices are doing, and make a plea to the public to be patient with our staff, instead of attacking them. GP staff have worked throughout the pandemic and have done their absolute best to support patients. We’re calling for the abuse to end now.”
The survey of 571 GP practice managers showed that 83% have had to remove a patient from the surgery due to multiple incidents towards their team. Other recent research from an NHS Staff Survey showed that 14.9% of respondents had been subjected to physical violence while in work. Much abuse goes unreported and national annual data on physical assaults against NHS staff are no longer published. The ‘If I die it will be your fault’ campaign aims to raise awareness of the zero-tolerance approach to abuse and encourage all practice staff to feel confident about reporting incidents.
Nicola Davies, a practice manager in Cornwall and founding member of the IGPM said: “We hope that by raising the personal effect of abuse on staff, we can encourage patients to be tolerant and understanding. Our staff are doing their job. It is never a personal vendetta to stop a patient from accessing healthcare.”
Kay Keane, a practice manager in Stockport and Director of the IGPM said: “A man attended our practice with six knives because he didn’t get the treatment he wanted. He smashed up the waiting room and threatened staff members. It was a scene we never want repeated in GP practice. It was terrifying and unnecessary. But we also know this is extreme. Bad language and threats are an everyday occurrence, and it is unacceptable.”
Jo Wadey, a practice manager in Worthing and founding member of the IGPM commented: "Receptionists are leaving their roles because of the abuse they receive, which means we are continually trying to recruit and train, which puts a huge strain on practices."
The ‘If I die it will be your fault’ campaign video can be found here, with practices up and down the country joining forces to share the message that abuse towards practice staff must stop.
Many people working in general practice will be concerned by the updated Standard Operating Procedure to support restoration of GP services, published on 13th May 2021, which advised GP practices on how to improve patient access. Dr Richard Vautrey issued a response on behalf of the GPC criticising the update on 14th May.
The NHSE letter was not discussed with the BMA General Practitioners Committee before it was published. This letter serves as guidance – it has no contractual force. We are expecting further clarification from the BMA and GPC regarding this matter and will share it as soon as it becomes available. Please be assured that Humberside LMCs have made our NHSE regional team aware of how unhelpful and counter-productive we feel this letter is.
To ensure that practices are in full compliance with the terms of their contract they should be:
- Offering patients access to your practice via telephone/online and your reception is also open;
- Offering patients face to face appointments based upon your assessment of clinical need following a discussion between the clinician and the patient;
- Offering on-line access for a proportion of your appointments;
- Offering a discretionary e-consultation (or equivalent) platform, which need only be during core hours Monday-Friday 08:00-18:30, and;
- Providing information about your services via your practice website
Practices are not obliged to offer patients a face-to-face appointment solely upon their request. The relevant parts of the Regulations are as follows:
4) The services described in this paragraph are services required for the management of a contractor’s registered patients and temporary residents who are, or believe themselves to be—
(a) ill, with conditions from which recovery is generally expected;
(b) terminally ill; or
(c) suffering from chronic disease,
which are delivered in the manner determined by the contractor’s practice in discussion with the patient.
(5) For the purposes of paragraph (4) “disease” means a disease included in the list of three character categories contained in the tenth revision of the International Statistical Classification of Diseases and Related Health Problems; and “management” includes
(a) offering consultation and, where appropriate, physical examination for the purposes of identifying the need, if any, for treatment or further investigation; and
(b) making available such treatment or further investigation as is necessary and appropriate, including the referral of the patient for other services under the Act and liaison with other health care professionals involved in the patient’s treatment and care.
Since March 2020, practices in the Humber area have remained open and continued to offer face-to-face appointments based on clinical need – this should not change, and the LMC will support practices to continue to practice in this way. The LMC is very aware that many GP colleagues, practice managers and practice teams do not believe they are now able to offer a consistently safe service to all patients. It is very disappointing that after all the efforts of the past year, general practice is experiencing unparalleled demand.
This latest NHSE letter panders to the illusion that the NHS can meet the limitless pool of patient demand, rather than a service based on need, and throws general practice to the media wolves. It also ignores the continuing concerns about circulating Covid-19 variants, and the need to maintain appropriate infection prevention and control procedures.
The LMC will continue to work closely with the local CCGs and the NHSE regional team. Our system partners and PPGs need to better understand the detail and data behind the scale and challenge around GP access, patient demand and workload.
We would encourage all colleagues to prioritise their own health and well-being, and not sacrifice themselves (and their families) in an attempt to manage impossible, unlimited, patient demand.
Richard Vautrey, Chair of the GPC has said in an update:
"Instead of knee-jerk responses to press headlines there needs to be proper acknowledgement from the Government and NHSE/I that practices are under huge pressure at the moment, that you are doing the right thing by working in line with national infection protection and control guidance as set out by the CMO and that you have been using telephone and online consultations appropriately to both keep patients and staff safe. This also needs to be much more clearly explained to the public."
"It is for practices to determine how best to manage and deliver their services and the best arrangements for appointments, based on their expert knowledge of their local community. Practices have the contractual freedom to do this taking in to account their capacity and workload pressures, and by doing so delivering a safe service to their patients."
"None of us trained to be call-centre GPs and we all want to get back to a time when we have the freedom to see more patients face to face but we need to do that in a way that matches capacity and safety within each practice. As covid-19 prevalence falls and, through the incredible efforts of general practice, vaccination levels rise practices are rightly and wisely adapting the arrangements they have had during the height of the pandemic. However, at present we know there is no spare capacity, there is no surplus workforce waiting to come and assist and the impact of the wider NHS backlog is having a massive impact on every practice. We know that Practices have been and will continue to offer face to face appointments for those patients who need them as well as trying to protect our patients and colleagues from becoming infected in our surgeries."
"We don’t just need our patients’ understanding, we have often had that throughout this last year, we need governments to act. We don’t just need short term fixes, or more letters and guidance telling us what to do, but a return to the freedom to deliver services in the way that best meets the needs of our patients, as well as long-term commitment to investment and development of general practice. That is what we will keep pushing for and what we expect government and NHSEI to deliver."
We are deeply concerned by the Covid situation in India as the country's healthcare system struggles to cope with the number of cases there. Many colleagues in the Humber have friends and relatives directly affected and we appreciate this will be a deeply worrying time for them. This is a short summary of actions and services which are being put in place:
A. There is a central NHSE response being coordinated by Prerana Issar with an emphasis on:
1. Advice on surge hospitals
2. Remote monitoring and management
3. Clinician to clinician telelink
4. Equipment inventory
B. The SAHF (South Asian Health Foundation), Academic Health Science Network (AHSN Network), and Learn with Nurses are running a series of webinars sharing NHS experiences of COVID-19 with health and care professionals in other countries. The next webinar is on Friday 7th May, 16:00-17:00 with the theme of Hospital and ICU Management of Covid-19 - sign up here. Details of further sessions will be posted on the South Asian Health Foundation events page.
C. These are some of the charities providing support to India
British Asian Trust Oxygen for India Emergency Appeal
D. BAPIO is also planning to provide free telemedicine support to health care staff in India. If you are interested in helping, please register stating your area of expertise and local language skills. Sign up link.
E. Please also check in with your colleagues here who have family in India. They may be distressed and have to take additional breaks to stay connected with friends and family. Also please signpost them to help available through wellbeing schemes - our support page has information and links to sources of support.