11 May 2023
By Anna Liveing, Account Manager, Evoke Incisive Health
“Try calling again at 8am tomorrow when more appointments will be released” – the familiar phrase heard by thousands of people every day up and down the country trying to secure an appointment with their GP. Also dubbed the ‘8am scramble’, the challenge in accessing GPs has become one of the most important political issues with a general election likely in just over a year.
There is no denying that staff in primary care are working at unprecedented levels to meet demand, with GPs seeing an average of 37 patients per day. That’s 148% more patients than the recommended safety guidelines. Both sides of the political divide recognise the gravity of the crisis, the impossibility of just asking GPs to do more, and the need to have a credible ‘retail offer’ for the electorate.
Last month, in a speech delivered at the King’s Fund, Wes Streeting MP (Shadow Secretary of State for Health and Social Care) set out his plans for the NHS to return to its roots as a “neighbourhood health service” by cutting waiting times and giving patients a greater range of choice in accessing appointments. Although full details are yet to be unveiled, Streeting spoke of placing a mental health hub in every community and increasing the use of pharmacists in delivering vaccinations.
The Government’s long awaited strategy, Delivery plan for recovering access to primary care, was published this week. Commonly known as the Primary Care Recovery Plan (PCRP), notable policy announcements include:
A Pharmacy First scheme to provide pharmacists with the powers to prescribe treatments for common conditions which would otherwise require a GP prescription
The introduction of a ‘Modern General Practice Access’ service to improve telephony services, simplify online patient-to-GP requests and enable faster navigation, assessment and response via digital tools
Visa flexibilities for newly trained GPs so they can stay in the UK and practice
Whilst these plans have been largely welcomed by the pharmacy and healthcare sector, Labour’s response has been somewhat muted. Both the Conservatives and Labour now seem to largely share a vision for pharmacy to increasingly have a role delivering primary care services – something that would have been contentious, at least on the Labour side, not that long ago. Whoever wins the next election, the number of front doors into the NHS looks set to increase.
However – as the Government acknowledges – this plan is just the first step in a longer-term approach to realising a vision of more accessible, joined-up, and personalised primary care. It is critical that the current and next Government, whatever its colour, gives due consideration to:
GP recruitment and retention
A survey carried out by the Royal College of General Practitioners found that 39% of the GP workforce across the UK is seriously considering leaving the profession within the next five years. Although the pension reforms announced in the Chancellor’s Spring Budget go some way to supporting the retention of experienced GPs, the eagerly anticipated NHS workforce plan will need to answer the outstanding, and fundamental, issue of recruitment and retention. Watch this space.
Clear and consistent public communications
The Government’s PCRP commits to a national campaign to help patients navigate to the most suitable primary care service – GPs, pharmacy or community – including guidance for Integrated Care Boards on how to develop locally led communications.
Encouragingly, there is already a healthy public appetite for pharmacies to offer an expanded range of services – but to transform this appetite into tangible behaviour change, public communications campaign must be an ongoing endeavour of clear and consistent information so that patients understand when, how and who they should contact – including the range of practice team and healthcare professionals that can support them.
Longer term funding
As a result of inflation, the community pharmacy sector highlight that there has been an estimated 30% real term cut in government funding over the last seven years. The additional £645 million in the recovery plan for Pharmacy First sets a positive benchmark as the Government heads into negotiations with the pharmacy sector on the next Community Pharmacy Contract Framework this summer. However, it is critical that longer term funding for pharmacy is secured to ensure they can continue to deliver these expanded services. Without this, there is a risk that the ‘8am scramble’ shifts from the GP to the pharmacy front door.
So what next for primary care?
Of course, politics never operates in a vacuum and where politics meets policy, successful implementation of primary care recovery policies will rest on the outcome of upcoming GP and pharmacy contract negotiations (not least the approach the BMA take to negotiations, given the imposition of the 2023/24 GP contract). Also in the mix is a wider scope of work to reform primary care, including the potential reconfiguration of GP financial incentives – with NHS England set to consult on the future of the Quality and Outcomes Framework this summer – and further exploration of policies to better integrate primary care, as set out in last year’s Fuller Stocktake report.
Ultimately there is a lot, politically and systematically, to grapple with. Whilst solving the ‘8am scramble’ for GPs by diverting demand to pharmacy and other community providers alone is unlikely to be a silver bullet for primary care reform, if implemented successfully it does hold the potential to ease some of the political headache and cut through with the general public.
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