Access To Primary Care
Access to Primary Care is a nationwide problem but it is particularly acute in the North West with Manchester having one of the highest levels of morbidity and North Manchester the highest levels within the city. This is exacerbated by a national shortage of GPs and nurses within primary care.
We Know that access to our practice at the moment is extremely difficult. This Is due to a number of factors. To improve access there needs to be a change in the balance of supply and demand .
On the Supply Side:
We have employed an extra salaried GP, a Physician Associate, an additional Practice Based Pharmacist and we employ Locum GPs using Covid recovery money and practice funds to provide additional sessions and cover some annual leave but this is still not enough. Locum GPs are often difficult to find at short notice when urgently needed.
We have received a small amount of Covid Recovery funding from MHCC to pay for extra Locum GPs, but this only amounts to 77p per patient for our practice and does not go very far, the distribution of this funding package across primary care has been very inequitable and there is a small practice nearby that has received over £4 per patient. We are awaiting a response from MHCC to see if this unfair lack of funding for our patients can be addressed.
We are trying to contribute to improving staffing for the future by training 2 GP registrars who are qualified doctors doing their postgrad training to be GPs, we educate medical students, and we are supporting a nurse in her training to be an advanced nurse practitioner who will be able to prescribe and are supporting one of our health care assistants training to be a Registered Nurse.
We have been the Lead Practice responsible for the local COVID Vaccination Centre for our PCN (Primary Care Network) covering over 45,000 patients . We have tried not to let this impact on core hours at the practice for our clinical staff, but it inevitably will mean that they have not been able to do extra hours at the practice if they were working there instead.
Practice input into the vaccination centre ended on 31st August 2021.
On the demand side:
Primary Care workload has increased exponentially.
Telephone triage remains in place to ensure the safety of our patients and staff as we are not yet in a position with the pandemic, especially in Manchester, to go back to packed waiting rooms.
This means every patient who requires a face-to-face appointment uses 2 appointments as they are assessed by telephone or video first.
We are dealing with sometimes 700+ incoming phone calls daily - these include requests for emergency appointments, urgent and routine appointments, requests for results, requests for medication, chasing up secondary care appointments, secondary care results, enquiries about covid vaccines and more.
Medication requests also come in via the pharmacists and the total can be 300+ daily.
Secondary Care is also struggling and because of this more and more work is passed to Primary Care including arranging monitoring bloods that would otherwise have been done at the hospital, chasing up results that have not been available at discharge, liaising with patients about missing results, missing appointments for follow up and delays to hospital treatment caused by the pandemic. These delays also mean that patients’ conditions worsen while they are awaiting treatment and they need more input from primary care in the meantime using up more of the available appointments.
Due to the pandemic patients have had delays to their routine chronic disease management and monitoring, these delays cannot go on indefinitely as their conditions may deteriorate and these patients must somehow all be fitted in to appointments. In addition, If these checks are not done then the practice loses income and is no longer able to afford the extra staff to do the checks in the first place thus reducing overall access to everyone.
The pandemic has worsened the mental health of the population, these people require a lot of input from ourselves as Community and Secondary Care Mental Health Support is overstretched.
We have been told we have to provide a certain number of appointments for NHS111 to book direct.
We have been told we must review everyone who has been seen at the Hot clinic, regardless of clinical need.
We have been told we must review everyone who has a positive Covid test, again regardless of clinical need.
Most patients have been amazing and have soldiered on with self-care and accessing our service only when necessary however there are those who have not managed so well and have used us as a first port of call for every minor ailment. We would like to remind everyone of the very extensive and helpful resources on our website and on NHS choices, NHS 111 by phone and online, as well as the highly skilled and professional help available through your local pharmacy. If more people could look for alternative routes for advice and help, we would hopefully have more appointments available to those with more serious and complicated conditions. Everyone needs to do their bit to ensure we can provide a service to those who need it most as the NHS does not have endless capacity.