Therese Coffey’s plan for the NHS turned out to be a wet squib. But even the lack of detail won’t prevent it from becoming a headache for GPs. Rachel Carter Reports
With a new prime minister comes a new health secretary, and Therese Coffey has been named the person for the job. Fifth incumbent in just four years, she inherits the file at a time when undoubtedly all parts of the NHS are in serious crisis.
Dr. Coffey began his tenure with a questionable assessment of primary care, announcing “doctors, dentists, chiropractors.” But his first real intervention in the post came in the form of the document Our plan for patients. Its publication was preceded by headlines about GPs due to see patients within two weeks and threats of rankings.
However, like most initiatives from its predecessors, the plan when it came was devoid of details, relying on sound bites and little else. Unfortunately for GPs, that doesn’t mean it won’t make their working life that much harder. Here we analyze its promises.
“We will expect that anyone who needs an appointment with their practice within two weeks will be able to get one… We will inform patients by publishing data on the number of appointments each doctor’s practice GP supply and waiting time for appointments, to enable patient choice’
Dr Coffey’s plan asks GPs to offer an appointment to ‘everyone who needs it’ within two weeks. Firstly, it ignores statistics showing that this is largely already happening: the latest figures from NHS Digital show that 85% of appointments in July took place within two weeks of booking. And second, nothing in the plan says what will happen to firms that don’t meet that deadline.
In an interview with LBC radio, Dr Coffey hinted that the penalty for the practices would be for patients to jump ship, meaning the practice would lose money. As Shadow Health Secretary Wes Streeting put it, it seems Dr Coffey’s message to patients is ‘get on your bike and find a new GP’.
More importantly for GPs, a patient wishing to make such a move will be able to view practice-level data on appointments, which the government intends to publish from November. This is not in itself a new commitment; former health secretary Sajid Javid made a similar pledge last fall in his own short-lived access plan.
Coffey’s promise will cause problems for the cabinets, which will have to be named and humiliated. Surrey GP Dr Dave Triska said releasing the data would ‘punish the most struggling practices’ which ‘is not helpful action’.
“All that will happen is practices will just block their appointments from two weeks on, so all appointments will be booked within two weeks, it’s easy to jump through the hoop,” he adds.
And in reality, the information is unlikely to be of much use to patients. Those who try to move
practice after viewing appointment data could experience similar wait times in neighboring practices, as this is a broader structural issue. Additionally, accepting new patients will only increase the pressures a practice faces given the current workload and workforce crises.
Regardless of the viability of the health secretary’s plans, the damage will already have been done, with patient expectations heightened. On the day of Dr Coffey’s announcement, GPs reported that patients were already calling and expecting an appointment within two weeks.
Nottingham GP Dr Irfan Malik told Pulse: ‘It has already caused tension with people calling into reception. It hit all the media and you know the government’s message was pretty clear, so already expectations have changed on the front line of patients – they want appointments within two weeks.
This can be expected to happen “across the country”, adds Dr Malik.
Dr Coffey has also committed to making 31,000 additional phone lines available to GP practices from January 2023. But as most practice staff will be quick to point out, additional lines are only used to nothing if there are not enough reception staff to respond to them, and insufficient clinical staff. to schedule additional appointments.
‘We will change parts of the NHS pension scheme to help retain doctors, nurses and other senior NHS staff, to increase capacity, fixing pension rules for inflation’
The Health Secretary appeared to heed warnings that the profession is losing too many experienced GPs to pension rules – and pledged in her plan to scrap inflation-linked pension tax.
One issue is the tax-free annual allowance (AA) charge, which applies when an individual’s pension increases by more than the maximum allowable amount of tax-free growth in a year. Simply put, high inflation affects the tax on doctors’ pensions, but is unlikely to inflate their actual pension. As the BMA puts it, this means doctors are potentially being charged on “a benefit they will never actually receive”.
The Department of Health and Social Care has said it will change the reassessment date of the NHS pension scheme to reduce the “risk of NHS staff facing tax charges on annual allowances due to high inflation”, which will benefit senior clinicians.
They would also include extending retirement flexibilities to “allow retired and partially retired staff to continue to return to work or increase their work commitments” without having their retirement benefits reduced or suspended.
However, the BMA said they were ‘adhesive plaster’ solutions.
Dr Vishal Sharma, chairman of the BMA’s pensions committee, said moving the reassessment date would ‘partly alleviate the problem’ but needed an urgent amendment to the legislation ‘to prevent doctors from being unfairly taxed on pension benefits that they will never receive”.
“We can hope to increase the number of appointments for patients by more than a million by releasing the funding rules to broaden the types of staff who work in general practice”
The press release that preceded the full plan promised that primary care networks would have the ability to recruit advanced nurse practitioners under the Additional Rules Reimbursement Scheme (ARRS) – something many GPs had been asking for.
However, the plan itself makes no mention of NAPs. Instead, it only presents proposals for “generalist assistants and advanced practitioners”.
When asked by Pulse, the DHSC said that two new roles – Generalist Assistants and Digital Transformation Managers – will be added to the Additional Roles Reimbursement Scheme (ARRS) from October 2022. The usefulness of this is a another question – a recent study showed that such health professionals did not reduce the workload of general practitioners.
The plan also sets out the intention to increase the number of mental health practitioners (MHPs) in primary care. Still, that seemed to echo updates made earlier this year to Network DES 2022/23, which ensured that NCPs would be able to employ twice as many adult mental health practitioners, with the approval from their supplier.
DHSC told Pulse that advanced nurse practitioners will be added to the program at a later date.
“We will expand the range of community pharmacy services, increasing patient comfort and freeing up GPs’ time for more complex patient needs”
Following the plan, the Department of Health and Social Care (DHSC) said pharmacies “will help ease pressures on GPs and free up time for appointments by managing and providing more medicines such as contraception without a prescription from a GP”.
He said it ‘could free up two million GP appointments a year’.
However, details of this ‘enhanced role’ for pharmacists remained scarce in the plan itself, which simply states: ‘Pharmacists will be able to manage and supply more medicines, without a prescription from a GP.
“We will seek to go further to give pharmacists more prescribing powers and make diagnostic tests available in community pharmacies easier.”
However, updates to the Community Pharmacy Contract, released alongside the plan, provide some substance.
They reveal that “Level 1 of a pharmacy contraception service” will be in place from January 11, 2023. The new service will allow street pharmacists “to provide ongoing management, via patient group management , routine oral contraception which was initiated in general medicine”. or a sexual health clinic”. They will receive a fee per consultation of £18, plus an initial ‘setup fee’ of £900.
“We expect the local NHS (integrated care councils) to step in where services need to be improved”
In line with the plan as a whole, details are missing on how and when Integrated Care Boards (ICBs) might be called upon to “step in”. But ICBs, by their nature, are not as local as CCGs, leaving GPs worried the actions will be more punitive.
Tower Hamlets GP Dr Selvaseelan Selvarajah said: ‘ICBs are still being created and we have no idea what exactly is going to be measured so I don’t see how intervening ICBs are going to help . CCGs would certainly have known which practices were struggling anyway, so I don’t know what new this will add.
He adds that a lack of local knowledge in ICBs could “absolutely” be a problem: “I don’t think ICBs have the capacity to manage general practice performance at the moment, even CCGs have struggled and now you have CCG fusions forming a lot of the larger corps, which are still being formed, not all roles – certainly locally – have been recruited, so I don’t know how this idea will work.
Tower Hamlets LMC chairman Dr Jackie Applebee says the plan does not include general practice: ‘Most of us use digital access alongside telephone or walk-in appointments, and in general, waiting times to see a general practitioner have decreased. In my office, we talk to most people within 24-48 hours of making contact.
“The pandemic has transformed access and Thérèse Coffey seems to be behind on this point.”