Dr. Geoff Jolliffe, chair of Morecambe Bay clinical commissioning group (CCG), told a meeting of the county’s strategic commissioning committee (SCC) – of which he is also a member – that GPs were busier than ever and that the hours they were putting in were “unsustainable”.
However, he said that Covid precautions and pent-up demand meant that need was now outstripping capacity in general practice.
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Analysis by the Local Democracy Reporting of data presented to board members shows that the total number of monthly GP appointments across Lancashire and South Cumbria in June this year was up by more than a quarter compared to February 2020, just as the pandemic was about to strike.
Meanwhile, the meeting heard that the proportion of patients receiving telephone consultations was almost four times higher between April and June 2021 compared to the same pre-Covid period back in 2019 – at 43.9 percent compared to 11.3 percent.
However, Dr. Jolliffe said that such stats were not a result of recalcitrance amongst GPs – and claimed that many aspects of his and his colleagues’ work now takes “a lot longer”.
“Typically, in my life…things are taking two to three times as long. The infection prevention control measures that we have [in place] really slow us down in face-to-face [appointments].
“There is a lot more complexity [of illness] at the moment – people have saved up a lot of issues and [are] presenting with several issues at once. So we’re doing a lot more activity and we’re taking a lot more time about it as well.
“The actual work in terms of hours GPs are inputting at the moment is massive and unsustainable.
“I think we have to say this, because…there’s a criticism in the media – supported by some elements of people working within the NHS – that, actually, GPs have been a bit lazy and have got their doors shut: and this is absolutely not the truth.
“I accept…that GP activity is not coping with demand – and that’s because demand is massive,” Dr. Jolliffe added.
SCC chair David Flory said that members understood “the work that’s going on in primary care and the pressures that are existing within those particular services”.
Back in March, Healthwatch published a report into patients’ experience of primary care during the first 12 months of the pandemic. That found that although telephone appointments were more convenient for some people, they failed to meet everybody’s needs.
NHS England told GPs in May this year to bring to an end the so-called “total triage” model that was implemented at the onset of the pandemic in an attempt to cut out avoidable visits to surgeries. Under that arrangement, all patients seeking a GP appointment were first assessed remotely to determine whether they could be dealt with over the phone or online instead of requiring a face-to-face consultation.
However, GPs were obliged to return to offering an in-person reception desk facility from mid-May. At the time, the Royal College of GPs pointed out that half of all appointments in the year since Covid struck had been carried out face-to-face.
Meanwhile, papers presented to the strategic commissioning committee show that GP referrals to the county’s four acute hospital trusts – which had plummeted during the the early months of the pandemic – were back at almost 95 percent of pre-Covid levels during the first quarter of 2021/22, compared to the equivalent timeframe two years ago.
However, most parts of the county are falling short of their own local targets for implementing an England-wide NHS initiative designed to reduce the number of patients being referred to hospital by their family doctor.
“Advice and Guidance” gives GPs and other primary care clinicians the chance to seek support from colleagues in secondary care – such as hospital specialists – about the best way to proceed with a patient’s treatment.
That can involve getting an opinion on how best to care for an individual, clarifying their test results or identifying the most appropriate service for them to be referred to.
The aim nationally is to avoid a third of face-to-face outpatient appointments each year – equating to around 30 million hospital visits.
Integrated care system (ICS) areas like Lancashire and South Cumbria have been told that they should be using Advice and Guidance in 15 percent of all cases by the end of this month.
However, six out of the region’s eight clinical commissioning group (CCG) areas missed pre-existing targets for the number of occasions on which they used the model during the first quarter of 2021/22.
The Greater Preston and Chorley and South Ribble areas were the furthest away from their ambitions – by some 41 percent – followed by Blackpool, which was almost 30 percent short. Fylde and Wyre CCG exceeded their target by nine percent, while Morecambe Bay overshot theirs by 26 percent.
Collectively, Lancashire and South Cumbria aimed to use Advice and Guidance 9,913 times between April and June. Overall, the region missed that target by just 1.5 percent – but if the Morecambe Bay CCG area – an early adopter of the practice – is stripped out, the target was missed by 23 percent.
Amongst the patients whose primary care clinician sought Advice and Guidance during that period, the number of outpatient appointments which would otherwise have been made was almost halved – while there was a more than four-fold increase in the cases dealt with by the original service which had been contacted by the patient, compared to the outcome that would have been expected otherwise.
Speaking about the overarching issue about the type appointments now being offered in primary care, West Lancashire CCG chair Dr. Peter Gregory told fellow SCC members it was vital to establish whether there was any resultant impact on hospital services.
“We’re still trying to understand what the right model of primary care should look like moving forward.
“We know we want to increase the number of proactive episodes of care through population health management [early intervention and tackling wider issues which affect health] and our capacity may be enabled by remote consulting – but we’re also perhaps dampened by an expectation to maintain a certain traditional model.
“It’s really important we understand the correlations between what we’re doing [in general practice] and how it impacts on secondary care,” Dr. Gregory said.