1 IN 4 GP APPOINTMENTS POTENTIALLY AVOIDABLE
NEW REPORT AIMS TO CUT BUREAUCRACY AND EASE PRESSURE ON GPs
A new report published today argues that perhaps 27% of GP appointments could potentially be avoided if there was more coordinated working between GPs and hospitals, wider use of other primary care staff, better use of technology to streamline administrative burdens, and wider system changes.
The Making Time In General Practice study by NHS Alliance and the Primary Care Foundation was commissioned as part of the work NHS England is doing with its partners to implement the NHS Five Year Forward View, and expand and strengthen GP services and primary care across England. The report was overseen by a steering group including the Royal College of GPs and the BMA GPs’ Committee.
The report finds that a significant amount of GP time could be freed up if family doctors were not having to spend time rearranging hospital appointments, and chasing up test results from local hospitals. This accounted for 4.5% of appointments in the study, an estimated 15 million appointments if repeated across England.
The report also estimated 1 in 6 of the patients in the study could potentially have been seen by someone else in the wider primary care team, such as clinical pharmacists, practice nurses or physician assistants, or by being supported to meet their own health needs.
The report states:

• 6.5% of their appointments could have been seen by another professional within the practice;

• 5.5% could have been seen by community pharmacy or the patient could have been given support to deal with the problem through self-care, and;

• 4% of appointments might have been dealt with through social prescribing / navigation.

In July, NHS England launched a £15m scheme to fund, recruit and employ clinical pharmacists in GP surgeries.
The study argues that the reduction of bureaucracy in general practice should be made a national priority; freeing up time for practices to work together, improving communication between general practice and hospitals, unlocking the potential for the whole system to work together, as well as supporting changes and improvements within individual practices. In particular the report calls for streamlined payment systems that GPs use, to simplify and speed up how much time practice managers spend on entering data.
Immediate practical steps to cut down on bureaucracy suggested by the report include:

• Patients who are unable to attend a hospital appointment should be able to re-book within two weeks without going back to the GP.  Booking and rearranging hospital appointments should be simpler without the patient needing to go back to the GP;

• Practices should employ a wider range of staff within the practice team, with the decision on the type of staff left to the discretion of individual practices and federations;

• NHS England will work with doctors to streamline communication, particularly between hospitals and practices, and reduce the workload of processing information within practices;

• Practices should free up time for GPs and other leaders in the practice to think through how they can work differently, learning the lessons from the PM’s Challenge Fund sites and the Vanguard sites as they become available – creating the ‘headroom’ needed to plan new ways of working and clinical innovation, and;

• GP federations should be funded to work across their practices to build practical social prescribing projects that offer real alternatives to taking up GP time with patients whose needs can be better met by other kinds of support in the wider community.

Dr Jonathan Serjeant, GP, co-director and co-founder of Brighton and Hove Integrated Care Service and National lead for NHS Alliance’s Accelerate programme, argues that using today’s IT patients should be given more control over their own patient records rather than this burden staying with GPs.
Dr Serjeant said: “GPs and their colleagues are experts in listening, supporting and diagnosing their patients. This is what we’ve been trained to do, and what we want to do.
“If applied quickly, the recommendations set out in this report, particularly those around extending the GP team to incorporate other health professionals, will help reduce the current levels of bureaucracy GPs face on a daily basis.
“The end result is that GP time is freed up, and people have access to all their information whenever they need it.”
Rick Stern, chief executive of NHS Alliance, and a director of the Primary Care Foundation said: “This report documents how general practice is struggling with an increasing workload and the urgent action required to relieve this burden. We want to ensure that GPs and their colleagues in general practice are freed up to deliver the job they were trained to do and care so passionately about.”
Dr Robert Varnam, Head of general practice development for NHS England, said: “General practice is the bedrock of healthcare and NHS England commissioned this report because we are determined to support GPs in reducing the pressures they face.  The findings include helpful suggestions which should free GPs to spend more time with patients most in need and further ways to reduce the administrative burden.”
 ENDS
 For further information please contact Sarah Wrixon, sarah.wrixon@salixandco.com, 07976 747067 or the NHS England Media Team on nhsengland.media@nhs.net, 0113 8250958 (office hours), or 07768 901293 (emergency out of hours)
The full report is attached to this release, and is online at: https://www.thehealthcreationalliance.org/mediacentre/making-time-in-general-practice/
Background
An audit of GP consultations was undertaken, with results provided from 5,128 consultations across England.
A survey of practice managers was also undertaken, to estimate the time taken by different types of externally mandated work. Results were provided by 250 practice managers.
The quantitative results were then discussed in detail through qualitative interviews and focus groups with clinicians and managers, including a roundtable event with NHS providers. There has been ongoing review of results and key themes by a national steering group with all the relevant professional bodies and leaders from seven organisations representing primary care have jointly signed a Foreword to the report.

• Dr Chaand Nagpaul, GP Committee, BMA
• Dr Maureen Baker, RCGP
• Dr Amanda Doyle, NHS Clinical Commissioners
• Dr Michael Dixon, NHS Alliance
• Dr Nav Chana, National Associationof Primary Care
• Russell Vine, Practice Managers Network
• Dr Peter Swinyard Family Doctors Association

NHS England has launched a £15m scheme to fund, recruit and employ clinical pharmacists in GP surgeries. The scheme is an important part of the New Deal for General Practice and is the result of close collaborative work with Royal College of General Practice, the BMA’s General Practice Committee, the Royal Pharmaceutical Society and Health Education England. More details are available here – http://www.england.nhs.uk/commissioning/primary-care-comm/gp-action-plan/cp-gp-pilot/
NHS England is investing £1bn over four years (from 2015/16) in a primary care infrastructure fund, with £10million being used to kick start the initiatives in the GP workforce action plan, developed by NHS England, Health Education England, the Royal College of General Practitioners and the BMA GP committee. This complements work that is already underway to strengthen the GP workforce. Full details can be found here: http://www.england.nhs.uk/commissioning/primary-care-comm/gp-action-plan/
NHS Alliance is an independent, not-for-profit, leadership organisation representing progressive providers of care outside hospital. Neither professional body nor trade union, it is an entirely solutions focused organisation, unique in its approach bringing together more than 10,000 passionate individuals and organisations across primary care who believe innovation, connections and integration are key to the sustainability of a health service that remains free to all at the point of need.
The Primary Care Foundation was established in 2006 to support the development of best practice in primary and urgent care. The foundation specialises in carrying out reviews, based on analysing a range of data sources and examining local practice, that make local and national recommendations.  It also look for opportunities to share learning, building resources that can solve problems more widely across the NHS.  The foundation has worked with over 1,300 practices in the last 4 years on managing access and urgent care, using a specially designed web-based tool to prepare reports for practices, and discuss ways of making improvements.
Making Time in General Practice – FULL REPORT 01 10 15

The Health Creation Alliance has supported the employment of pharmacists within General Practice through their document ‘Pharmacists and General Practice’ and within ‘Making time in General Practice’. We have also been great supporters of the commitment to pump prime pharmacists in General Practice and the work of NHS England in driving forward the successful pilot into full roll out. We have also seen the value and contribution that pharmacists in General Practice can make.
However, it is simply not enough. The 1,300 practices across London, who are currently surviving in a very challenging environment are allocated just 84 between then – and many are disappointed at this level and the lack of alternatives.  In Wandsworth community pharmacists have stepped in and supported General Practice on a sessional basis. Last year The NHS Alliance published their report ‘Supporting the development of community pharmacy’. The report offers 8 recommendations on ways to engage community pharmacists in managing the demand in General Practice. We know that several GP federations have approached Local Pharmaceutical Committees asking what more Community Pharmacy can do.
The Health Creation Alliance believes that demand in General Practice is at a critical level. We know that working in ways that promote health creation can also help to reduce demand, and we would welcome urgent action to support community pharmacy to go further to manage demand and adopt health creating practices.
Health Creation Alliance pharmacy lead, Mark Robinson, said:
“We have always said that Community Pharmacy is an under-utilised resource. It is time to sort this out and find ways of engaging and supporting community pharmacy to work closely with General Practice and with communities to manage demand.”

Ends

Notes to editors:

• For enquiries, interviews or further comment,  please contact: Judy Harris at judyharris15@aol.co.uk  or on 07717 691845
• Health Creation Alliance mission is … ‘to infect the UK health system with wellness’. You can find more information here
• Health Creation Alliance has a goal to make Health Creation and health creating practices a core part of the UK healthcare system alongside a greater focus on prevention. We believe that this is the best way to reduce health inequalities and deliver a sustainable health service. Click here for a short briefing paper on Health Creation.
• You can find coverage of our Health Creation Action Summit here

The NHS Alliance welcomes today’s report from Sir Bruce Keogh, New blueprint for urgent and emergency care across England, and is encouraged to hear that he does not believe that there is a quick fix or immediate solution to creating excellent urgent care services. We agree that this will take a lot of time and hard work, and everyone will need to show commitment over the next three to five years, and not just the next six months, if we are to really to improve urgent and emergency care services across England.

We are also pleased to see that Sir Bruce Keogh explicitly mentions dissolving traditional boundaries between hospital and community-based services, as the Alliance called for the exact same thing in March this year in our manifesto for primary care, Breaking Boundaries: nhsalliance.productionserver.co.uk/manifesto. We strongly believe that there needs to be more integration between primary, secondary and community services, and it is encouraging to see that there is mention of broadening care to include nurses, pharmacists and the wider community team.

There are major challenges in making the changes required.  We need to trust local leaders working closely with their communities to explore what will work best, with the freedom to adapt centrally directed initiatives such as NHS 111 so that they are more flexible and avoid directing more patients to hospital.

Direct booking of appointments in general practice may make sense but will require a major shift in the way most practices work.  Similarly, too great a focus on same day access in general practice may actually make things worse rather than better – we need to ensure that as patients we can get an appointment when we need one, which is often two or three days ahead, rather than a same day appointment being the only option.  Small improvements across thousands of practices will have a greater impact than too great a focus on the pressures in A&E.

–       Notes

The NHS Alliance’s report, released in November 2011, ‘Breaking the Mould without breaking the system: new ideas and resources for clinical commissioners on the journey towards integrated 24/7 urgent care’, provides a whole system perspective of urgent and emergency care for clinical commissioners.

NHS Alliance is the leading independent voice for primary care, bringing together patients, frontline staff, providers and commissioners bound the common values of the NHS. Its core purpose is to work collaboratively to improve health care within a sustainable NHS, facilitating new and better ways of delivering services through its networks and campaigns. It welcomes patient-focused organisations and individuals of all disciplines, representing them to government and its agencies to influence policy in the interests of all its members.