BMA lambasts UK Government’s ‘Rescue Package’
The latest Emergency Department performance figures for September 2021 published today by NHS England show the highest number of 12-hour stays on record, the highest number of four-hour stays on record, and the worst four-hour performance ever recorded.
The latest figures were published on the day the UK Government set out it’s Plan to improve access for NHS patients and support GPs.
The data show in September 2021 there were 1,392,542 attendances to Type 1 Emergency Departments in England.
Four-hour performance has deteriorated for the sixth consecutive month, once again reaching a record low. Just 64% of patients in Type 1 Emergency Departments were admitted, transferred or discharged within four-hours.
A record breaking 5,025 patients stayed in an Emergency Department for 12-hours or more from decision to admit to admission. This is an 80% increase on the previous month, August 2021, and it is the highest number of 12-hour stays since records began and is almost a third higher than the previous highest, recorded in January 2021. The number of 12-hour stays from time of arrival is not published but is likely to be significantly higher.
Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “This data is bleak and is a stark warning of the crisis that we are heading towards this winter.
“Dangerous crowding has returned to Emergency Departments, exit block is preventing a flow of patients through the hospital, and there have been widespread reports of ambulances queuing outside hospitals facing long handover delays.
“For patients, this means long and potentially frustrating waiting times in the Emergency Department. For staff it is incredibly challenging, as they do all they can to continue to deliver care quickly amid rising attendances and pressures.
“At the same time the health service continues to manage covid as cases have been rising steeply, with the NHS now treating around 14 times as many patients as the same time last year.
“Trusts also continue to deliver elective care but there is a real threat that in the coming months this may once again have to be paused to manage pressures on urgent and emergency care and the rising number of covid cases.
“The winter presents a significant challenge for the health service; staff are increasingly worried about the NHS’ ability to cope. The Government need to recognise the potential crisis and support the health and care service as it tackles the challenges ahead.
“NHS England’s Urgent and Emergency Care Recovery 10 Point Action Plan is a blueprint on how to manage these pressures in the short and medium term. Trusts must do all they can to follow this guidance to mitigate pressures across the system and prevent further deterioration in performance.
“But the underlying cause of all of the problems facing the NHS is a decade of underfunding. The health service has for a long time struggled to meet the demand of the population. It is short on staff across the board; capacity has not risen in line with demand. Existing staff are exhausted, with many looking to leave after having to shoulder an ever-increasing workload.
“So far promises to increase the workforce have fallen short. The forthcoming spending review is an opportunity for the government to signal it’s intent to boost staffing with a long-term workforce plan and rescue the NHS in the long run.”
Meanwhile the NHS, working closely with the Department of Health and Social Care, has today published a blueprint for improving access to GP appointments for patients alongside supporting GPs and their teams in England.
Surgeries will be provided with additional funding to boost their capacity to increase the proportion of appointments delivered face to face, as part of a major drive to support general practice and level up performance, including additional efforts to tackle abuse against staff.
The measures, including a £250 million winter access fund from NHS England, will enable GP practices to improve availability so that patients who need care can get it, often on the same day if needed. The investment will fund locums and support from other health professionals such as physiotherapists and podiatrists, with a focus on increasing capacity to boost urgent same-day care. This is in addition to £270 million invested over the previous 11 months to expand capacity and support GPs.
Amanda Pritchard, chief executive of the NHS, said: “Improving access to high quality general practice is essential for our patients and for the rest of the NHS too.
“It is a personal priority and today NHS England is taking both urgent and longer term action to back GPs and their teams with additional investment and support.”
Secretary of State for Health and Social Care Sajid Javid said: “I am determined to ensure patients can see their GP in the way they want, no matter where they live. I also want to thank GPs and their teams for their enormous efforts in the most challenging times in living memory.
“Our new plan provides general practice teams with investment and targeted support. This will tackle underperformance, taking pressure off staff so they can spend more time with patients and increase the number of face-to-face appointments.
“Alongside this we are setting out more measures to tackle abuse and harassment so staff at GP surgeries who work so tirelessly to care for patients can do so without having to fear for their safety.”
The NHS England document makes clear that every GP practice must seek patients’ input and respect preferences for face to face care unless there are good clinical reasons to the contrary.
The extra investment will help to increase the number of appointments delivered, while local health systems will be free to determine how best to tackle particular challenges to access and provision of care in their own community, which could include putting in place additional resource for walk-in consultations.
Local plans will need to deliver these improvements in access, with practices that do not provide appropriate levels of face to face care not able to access the additional funding, and instead offered support to improve.
Under the plan, the NHS will also support upgrades to telephone systems, ensuring that more patients can quickly and easily speak to general practice staff, and help the public avoid long waits when contacting a surgery by phone.
The government will also reduce administrative burdens on GPs by reforming who can provide medical evidence and certificates such as FIT notes and DVLA checks – freeing up time for more appointments.
UKHSA will complete its review of infection prevention and control (IPC) guidance in general practice and set out practical steps on IPC measures in GP settings which could increase the number of patients that can be seen.
As part of this package, the NHS will increase its oversight of practices with the most acute issues in relation to access, and GP appointment data will be published at practice level by spring next year. This will enhance transparency and accountability, as monthly data is currently only published by clinical commissioning group.
In addition, patients will get the opportunity to rate their practice’s performance, via text message, based on their most recent experience of accessing support. This survey, which has been previously agreed with the profession, is being piloted in around 60 practices and will be rolled out next year.
Together with the government and Academy of Medical Royal Colleges, the NHS will also develop a zero-tolerance campaign on abuse of NHS staff, including GP teams.
General practice teams have delivered more than 300 million appointments over the last year as well as delivering the vast majority of Covid vaccinations, saving lives and protecting millions of people against the virus at speed.
Health Minister Maria Caulfield said: “As a nurse on the frontline during the pandemic I know how hard GPs and their teams have worked, while recognising how badly so many people want to see their GPs in person.
“This plan will give our dedicated general practices the support needed to increase capacity, boosting the number of appointments for patients to see and speak to their GP practice.
“I look forward to continuing to work with the sector to ensure patients can get the care they need.”
Patients will also be able to see different types of clinicians in general practice, who can best meet their needs and conditions, including pharmacists, paramedics, advanced nurse practitioners and nursing associates.
NHS England will also work with the government to consider how far and fast the role of pharmacists can be increased in the supply of medication, as part of relieving workload on GPs.
Government’s ‘rescue package’ for GPs is flawed and patient care will suffer as result, warns BMA
“It’s truly frightening that we have a government so ignorant to the needs of such a core part of the NHS”
Responding to the publication by the Department of Health and NHS England and NHS Improvement today, outlining their plans to improve access for NHS patients and support for GPs, BMA GP committee chair Dr Richard Vautrey said: “After weeks of promising an ‘emergency package’ to rescue general practice, we’re hugely dismayed that whilst additional funding has been promised, the package as a whole offers very little and shows a Government completely out of touch with the scale of the crisis on the ground.
“GPs and their teams will now be facing the worst winter for decades, and as a result, patients’ care will suffer. Appointments will be harder to book, waiting times will get longer, more of the profession could leave and GPs will struggle to cope.
“It is also disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments; we need a more intelligent conversation about the variety of appointments and care that are available to patients to meet their needs.
“While in-person consultations are a key feature of general practice and absolutely necessary for some patients and certain conditions, the pandemic has proven that in many other cases, phone or video appointments are entirely appropriate and appreciated by patients, and a crude focus on percentages or targets is completely unhelpful.
“Throughout our discussions with ministers and NHS England in recent weeks, the BMA has been clear that without a concerted effort to reduce bureaucracy, admin and red tape in practices, patient access and care was at risk.
“Unfortunately, today’s offer merely tinkers around the edges, and will not reduce the unnecessary burden practices carry and therefore free up any more time for doctors to see more patients. We need an end to target-driven, payment-by-results, care and allow practices to look after patients in a way that is flexible and right for the person in front of them and the Government have missed an opportunity to tackle this.
“Reducing the administrative burden on GPs by reforming who can provide medical evidence and certificates such as Fit notes and DVLA checks, won’t happen for some time and is a mere drop in the ocean as what is needed is urgent action now to free up sufficient time for more appointments.
“While the additional £250m is welcome, it must be easy for practices to access rapidly and they must not be forced to have to produce reams of plans or try to meet unattainable targets to get it – which has often happened in the past.
“We had four simple asks – and only one appears to have been fully answered. Increased sentencing for assaulting healthcare workers is something we asked for, but meaningless if the same Government refuses to address the crisis fuelling such abuse. The Secretary of State has started to address a second, by talking more positively about general practice but he needs to do much more to publicly support the profession when we are under such pressure and facing a torrent of abuse on a daily basis.
“These proposals will only confirm the profession’s belief that ministers and NHS England fail to understand the dire state of general practice – or that they, not hardworking GPs, are to blame.
“It’s truly frightening that we have a government so ignorant to the needs of such a core part of the NHS. GPs want to improve the care we offer to our patients, but today’s offer will not enable us to do that as we had hoped.
“GPs across England will be truly horrified that this is being presented as a lifeline to general practice, when in reality it could sink the ship all together. There can be no doubt that this lack of action at such a critical time will force many GPs to hang up their stethoscopes and leave the profession for the last time.”
