The Royal College of General Practitioners (RCGP) says that the time spent preparing for inspections by the Government’s regulator the Care Quality Commission and other ‘red tape’ takes GPs away from where they are needed most – delivering safe care to patients and reducing waiting times for GP appointments.
At the weekend, the RCGP’s governing Council voted overwhelmingly in favour of the emergency motion: “In response to the Secretary of State’s announcement that GPs are the ‘jewel in the crown’ of the NHS, Council asks the Chair of Council to write [to him] asking for an immediate pause in the CQC’s programme of routine inspections in order for practices to better manage their workloads. Council calls for an urgent review of CQC inspections and regulatory processes.”
The College claims that a temporary halt to the inspection process would prevent general practice from going into meltdown in the next six months as the family doctor service struggles to cope with rocketing patient demand and an increasingly insufficient number of GPs, putting patient safety at risk.
In an open letter to the Health Secretary, RCGP Chair Dr Maureen Baker warns that the burdens being placed on GPs by the CQC inspection regime, and pressures to provide seven day access for routine care – as set out by Mr Hunt in a speech last Friday – are undermining efforts to turn around the crisis in general practice.
She says: “In the view of RCGP Council, the current inspection process tends to focus on those things that can be most easily documented and generates considerable additional clinical and administrative activity for practices. We believe that the time has come to conduct an urgent review of the CQC’s regulatory regime, to eliminate unnecessary bureaucracy and to ensure that it reflects the distinctive nature of general practice and focusses on what matters most to patients.
“Whilst this takes place, we call for the CQC’s programme of routine inspections to be halted on a temporary basis, as a means of alleviating the pressures on general practice which have now reached such an extent that they are giving rise to serious patient safety concerns. This would not, of course, preclude the CQC from conducting inspections of practices where specific reasons existed for doing so, for instance were a practice to be subject to a significant level of complaints.”
New RCGP research shows that every family doctor could gain 120 additional hours per year to care for their patients if the Government were to reduce by half the general administrative burden that is currently imposed on GPs.
If the additional time was used to cut waiting times for GP appointments, the College estimates that patients would be able to secure an appointment to see their GP in under one week on nearly 12m more occasions a year – reducing the number of occasions on which patients have to wait more than a week for an appointment by just under 20% from 62.4m to 50.6m each year.
Turning to seven day access, Dr Baker says in her letter that Mr Hunt has signalled a clear aspiration that GPs should be looking to roll out seven day access to routine general practice care, despite concerns – repeatedly expressed by RCGP – about the implications for severely overstretched GP practices across the country.
“Our members are extremely concerned about the impact such a move would have on their ability to keep vital services up and running for patients. In the current climate – with huge concerns about current and future workforce capacity, and experienced GPs retiring due to high stress levels – we believe it is unrealistic to talk about achieving seven day access for routine GP care, “ she says.
“As the College has been highlighting through our Put patients first: Back general practice campaign, and as you noted in your speech, successive governments have under-resourced and undervalued general practice, with the result that GPs are in no position to take on extra work. Attempting to force through seven day working without a significant boost in resources and workforce would cause general practice to go into meltdown and would irreparably damage patient care.
“We are concerned that there is a real risk that the emphasis being placed on expanding seven day working will place unrealistic expectations on general practice and have a negative impact on efforts to recruit and retain more GPs. With morale already at an extremely low ebb within the profession, telling GPs they must work longer hours – when workloads are already so high – will make it harder for us to attract young doctors into general practice, and lead to more of our current workforce retiring early.
“We urge the government to give assurances to concerned GPs across the country that plans to move to seven day working will not be forced through whilst our concerns remain unresolved. “
Independent research commissioned by the RCGP has shown that the cost of extending GP hours beyond the current contract so that one in four surgeries open late and at weekends would cost at least £749m per year – rising to £1.2bn if one in two practices were to take part. This is vastly in excess of the limited one off funding for extended hours pledged by the Government through the GP Challenge Fund.
There are now 370m patients consultations in general practice every day – 60m more than even five years ago and 150,000 extra consultations per day.
But as patient demand has rocketed due to the ageing and rising population, and GP caseloads are becoming more complex, the share of the NHS budget for general practice has fallen to an all-time low of just over 8% in England.
There is a severe shortage of GPs caused by large numbers approaching retirement age and a ‘mass exodus’ of doctors leaving the profession or going to work abroad due to pressures of work, while insufficient numbers of medical graduates are going into general practice to replace them.
The College launched its Put patients first: Back general practice campaign in November 2013 to increase the share of the NHS budget for general practice to 11%.
Its Blueprint, published after the General Election, sets out five actions that must be taken by the new Government to strengthen general practice for the future: These include increasing the GP workforce by 8,000 and giving GPs more time to focus on patient care.
Concluding her letter, Dr Baker says: “The RCGP wishes to work with the government to deliver change for general practice, and there is much that we have welcomed in your speech. We have been calling for a ‘new deal’ for general practice for some time, and have set out in our Blueprint the specific measures that we believe now need to be taken to translate this into reality. However, we have always been clear that measures to increase resources, boost GP workforce capacity and reduce bureaucracy in general practice are needed to shore up current services and make them sustainable for the future – not as a trade off for expanding practice opening hours.”
RCGP Press office: 020 3188 7574/7575/7581
Out of hours: 0203 188 7659
Notes to editor
The Royal College of General Practitioners is a network of more than 50,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.