On 1st April 2023, the UK Government imposed a new contract on GP services throughout the UK, which GPs and the British Medical Association (BMA) argue is unsafe and compromises patient care. One of the main issues of contention relates to accessing your GP surgery. The contract states:
‘Offer of assessment will be equitable for all modes of access: To ensure consistency in the access that patients can expect, the GP contract will be updated to make clear that patients should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice. Practices will therefore no longer be able to request that patients contact the practice at a later time. The IIF focus on access will support practices and PCNs working towards achieving this during 2023 recognising the changes that will need to be made.’
In theory, this sounds amazing, any patient who wants a consultation on that day will receive a consultation on that day. Fantastic. Unfortunately, there is no increase in the workforce (GPs, Advanced Nurse Practitioners, Nurse Practitioners etc) to cope with the additional demand. The BMA and European Union of General Practitioners recommend a safe level of patient contacts per day to be somewhere between 25 to 28 appointments. The UK Policy Exchange and Sajid Javid agreed to this level of working when he was in post.
Assessing 28 patients per day allows the patient sufficient time to express their concerns, the GP time to listen, consider and assess the patient, perform any necessary examination, and come to a mutually agreeable resolution, ensuring the patient receives the best possible care. There is then sufficient time left over to manage the various administrative letters and requests, medication and prescription queries, review incoming test results and chase information needed to help each patient get the best outcome. In contrast, and purely as an example, on 27th March 2023 I personally recorded 114 patient contacts over a 13-hour day.
Consequently, we have to look at how we manage the requests that come in. We will continue to open the Ask My GP service at 8 am each day, allowing patients with internet access to complete a request online or those without to call the surgery and have the reception team complete it for them. Once each clinician (GP, ANP etc) is full up (we have rounded the number to 30 per day for each of us, a level we have discussed and feel is safe and within our ability to manage competently), the Ask My GP service will be switched off as we have done so for the last 2 years.
Any patient who then calls the surgery asking for an appointment will have their details recorded by the reception team, who will then pass them on to the senior GP that day to triage. The GP may need to call you, or they may have sufficient information within the request to determine the best outcome. There are 4 possibilities following the triage process, as follows:
- The GP agrees that the symptoms need to be dealt with today. You will be directed to a service which is able to provide that on-the-day treatment (A&E, Urgent Care, 111 etc)
- The matter needs to be dealt with but not today. You will be placed on a waiting list and contacted within a number of weeks appropriate to the complaint.
- The complaint can be treated by attending the pharmacy.
- The complaint can be managed by the patient, and relevant information on how to do so will be provided.
The outcome and any additional information will be communicated via a response to Ask My GP (if available) and/or a text message to the patient’s registered mobile phone number. If the GP feels you should attend A&E or urgent care, the patient will be telephoned advising them of that, but please check both emails and text messages after submitting the request.
This is not a permanent solution, and the BMA is continuing to try and negotiate with the UK Government. Our primary focus is to provide the best patient care we can, ensuring that it is safe for patients, but also the staff of Glebe Park Surgery.
I understand that many of you will have questions. Please do not take out any frustrations on the reception team, ANPs or GPs, or any members of staff who work at or who work with Glebe Park Surgery. We are all doing everything we can to do the best for our patients. Feedback forms are available in the reception area, please complete them and we will review them at our monthly internal meetings.
Dr Rob Jackson-Lawrence
