Speaking to GPonline for a special episode of its Talking General Practice podcast ahead of the college’s annual conference this week, Professor Martin Marshall said that such measures were essential in the short-term until more GPs and other primary care staff could be recruited to deliver a long-term solution.
Professor Marshall said he thought that the government had not understood the pressures on general practice ‘until recently’, but added that he felt health and social care secretary Sajid Javid had seemed ‘receptive’ to addressing workload issues at a recent meeting between the two.
‘The principal solution [to the workload crisis] is a larger workforce and that’s not going to happen quickly,’ Professor Marshall said. ‘But there are some things that we could do in the short term in order to improve the lot of general practice.’
Talking General Practice
Listen to the interview with Professor Martin Marshall in our podcast here
Cutting back QOF
He said that reducing the time GPs and practices spent on ‘contract compliance’, in particular scaling back the QOF, was one thing that could help.
‘I’m not saying QOF is a bad thing,’ Professor Marshall said. ‘I am saying that it’s a low trust way of managing professional activity. If you trust GPs to do the right thing, the vast majority of them will do so. We don’t have to spend as much time ticking boxes as we do at the moment.’
The government also needed to reduce the burden of regulation on practices, the RCGP chair said.
‘I do believe that regulation serves a purpose in healthcare, but the current model is disproportionate in general practice.
‘If the CQC as a regulator focused on the small number of practices that are really struggling and gave them positive help to get out of the place they’re in, and left the vast majority of general practices to get on with the job rather than being distracted by regulatory activity, that would be a very positive thing.’
Professor Marshall said he had raised these issues with the health secretary at their recent meeting, along with suggesting that some tasks GPs were responsible for could be taken on by other healthcare professionals.
He suggested other groups, such as physiotherapists and hospital staff discharging patients, could take on responsibility for some fit notes.
Meanwhile, routine prescribing for stable long-term conditions or contraception could be done by other members of the primary care team. Professor Marshall said that current constraints preventing this, including legislative changes to allow other health professionals to prescribe or increasing the number of training courses available, could ‘be overcome very quickly’.
Better electronic transfers of information between primary and secondary care could also go some way to mitigate work from hospitals that was being inappropriately transferred into primary care, Professor Marshall added.
He said: ‘[These are all] things that could be delivered, if not in weeks or months, fairly quickly. And whilst they wouldn’t have a massive impact on our overall workload, they’d at least be making a very strong statement from politicians and policymakers to general practice – that we’re here with you and we’re trying to do what we can to help you.’
Professor Marshall estimated that ‘at least 80% of the answer’ to the workload crisis lay in a larger workforce. He added that the remaining ‘20% of the answer lies in reducing bureaucracy, and changing the help-seeking behaviour of patients and supporting [them] to access service in different ways’. This included using ‘non-professional services where patients can and where it’s safe and appropriate for them to do so’.
The RCGP chair also said that during the pandemic general practice had learned it could do things remotely that it had previously thought not possible.
Professor Marshall said the current balance between face-to-face and remote appointments, with about 60% of consultations taking place in person, was ‘about right’.
‘I’m actually pretty confident that in a year’s time patients and politicians and clinicians will get used to that fact,’ he added. ‘Remote consultations are here to stay, not necessarily because they’re more efficient, because in many cases they’re not, but because actually they’re more convenient, they’re more patient-centred and we want to provide patient-centred care in general practice.’
A review of bureaucracy in general practice was promised as part of the 2020/21 GP contract and the BMA has also been lobbying for the government to take steps to cut unnecessary admin in recent months. In an update to its members the association said it was expecting the DHSC to share proposals on how to tackle rising levels of abuse in primary care and unsustainable workload by the end of last week.