North West London health bosses have been publicly eating large helpings of humble pie since their plan to change how patients see their GPs were leaked to health campaigners and caused outrage among GPs, local politicians, NHS campaigners and large parts of the national media including the specialist medical press.
In their initial plan, patients who wanted Same Day Appointments (SDAs) with their GP practice would have their phone calls diverted to a ‘hub’ where somebody unknown, NOT a GP, would decide whether they would be seen by a doctor. Only ‘complex’ cases would be put through to their own practice.
Most appointments would NOT be carried out by a doctor. Indeed, a care coordinator will refer a patient on to a pharmacist, physiotherapist, a practice nurse or a physician associate with just 2 years medical training – with only one GP hovering in the background. In most practices a TRAINED doctor carries out triage and decides who in their practice team is the most appropriate clinician to see a patient. The doctor is fully trained in diagnostic skills. This ensures patient safety and continuity of care within a home practice. Currently both the health secretary, Victoria Atkins, and the aspiring opposition health secretary, Wes Streeting, have been keen to stress the importance of continuity of care with a named GP or practice.
Although the NW London ICB prides itself on public engagement, no members of the public or public representatives and few GPs were aware of the plan until it was leaked into the public domain in late January.
Since then, health bosses have endlessly complained about being ‘misunderstood’, and claimed that ‘misinformation about their plans was being spread’. There was particular resentment against those NHS campaigners, GP organisations and specialist health care journalists who had read ALL of the documents and given an accurate account of what the plans entailed.
One line pushed by the ICB bosses was that they were being pushed into the introduction of Same Day Hubs by NHSE – the top of the NHS. Even this week at the NW London ICB Board meeting, CEO Rob Hurd said that they had ‘a national policy imperative for same day access from the NHSE Fuller Report’. Perhaps, seeing such alarming signs of revolt among GPs, who recognise that their skills are being sidelined by these proposals, primary care government minister, Andrea Leadsom, said:
The Department and NHSE do not encourage ICBs to implement any particular model and our position remains that these decisions must be made by clinical staff locally, taking into consideration patient choice and incorporating patient feedback gathered when testing new models.
(Pulse, 18 April, 2024)
There has been a partial retreat by health bosses. The new plans, which were originally to be mandated on GP practices by April 1st this year, are now to go ahead at a slower pace, the severe financial sanctions against GP practices which fail to sign up to the plans have been postponed for a year, there is to be further ‘engagement’ (unspecified!) with stakeholders and there are a small number of references to patients and the public in recent ICB papers. However, behind the swallowing of humble pie, local health bosses have not taken the unpalatable plans off the table – just pushed them a little further into the future.
At this point, neither GP organisations nor health campaigners show any signs of backing off. We value our GP practices. And we fear that if the plans were to be pushed ahead, now or at a later date, many GPs will be replaced by lesser trained but significantly cheaper staff. The trust is that GP services nationally and GP practices locally are being severely underfunded by the Government and nothing in the recent budget shows that the Government is willing to recognise the importance of our GP services.
The recent decision by Fulham-based GP at Hand to sack up to 150 GPs and to replace them with cheaper staff – probably physician associates – points to the key reason as to why patients and GPs need to stand together to defend a high quality GP service.