League tables for surgeries do not ‘make any sense whatsoever’, GPs’ leader says


Government plans to publish league tables for GP surgeries and allow patients to rate their performance via text message do not “make any sense to me whatsoever”, the head of the Royal College of GPs has told Sky News.

Professor Martin Marshall said a new package of support for GP surgeries in England, which ministers say will help them “see more people face-to-face and more promptly”, fails to “address the fundamental problems” facing practices.

Under the plan to improve access, practices which fail to provide an “appropriate” level of appointments in person will not be eligible for new NHS England funding worth £250m, with league tables ranking how much access surgeries are providing.

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‘I believe in choice’ for patients to see GPs

Patients will also be able to rate their practice’s performance via text message.

Reacting to the proposals, Prof Marshall said: “Of course any money, even short-term funding over the winter period, is welcome. But it doesn’t address the fundamental problems. The fundamental problems are deep-seated.

“For more than a decade, general practice has been under-invested in, we’ve had an increasing workload and more consultations, more complex consultations, more things that we can do, but the number of GPs is actually dropping.

“This offer from the government doesn’t address that fundamental problem.”

More on Nhs

Asked for his take on league tables and text ratings, he said: “GPs have always been receptive to patient feedback.

“There are many different ways, established ways now, of patients being able to feed back their experience of general practice.

“I think the idea as part of this so-called offer, that GPs should be in some way or other held to even greater account, put under even more of an administrative burden, in order in some ways to improve care, just doesn’t make any sense to me whatsoever.”

Prof Marshall said GP practices are already struggling under a “massive burden” and “struggling to deliver what we’re trained to deliver and what we know our patients want and need”.

He was speaking to Sky News after telling the RCGP conference that some politicians and sections of the media were engaging in “abuse” of medics, describing it as “demoralising and indefensible”.

Prof Marshall said GPs have been engulfed in a “public storm over face-to-face appointments”.

“The malicious criticism of the profession by certain sections of the media and by some politicians as a result of the shift towards remote working – introduced to keep our patients and our team safe and keep the service operating – has been the worst that I can remember in over 30 years as a GP,” he said.

“This widespread vilification of hard-working GPs and our teams is unfair, it’s demoralising, and it’s indefensible. No-one working in general practice deserves this abuse.”

Speaking to delegates, Professor Chris Whitty, England’s chief medical officer, said the issue of face-to-face appointments had received “rather more heat than it needs”.

He did suggest that there could be more in-person consultations, but urged GPs to pay no mind to negative media coverage.

“I would stick to the advice that is an old saying, but it’s completely right, which is never worry about criticism from somebody you wouldn’t take advice from,” Prof Whitty said.

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NHS backlog leaves GP surgeries struggling

Dr Michael Mulholland, vice chair for professional development at the RCGP, told the conference there had been a “change” to the line-up and Health Secretary Sajid Javid would not be addressing them as previously planned.

“Unfortunately we do have one change to the programme. The Secretary of State for Health for England is unable to join us today either in person or by video link,” he said, prompting laughter in the audience.

“This is because, and I need to get this right, he had to ‘clear his diary to ensure he can fight for the NHS in the spending review, or be anywhere else you may have seen or heard him this morning’.”

Speaking to Sky News earlier on Thursday, Mr Javid said providing “more data, more transparency” would help raise standards.

“It is important that patients have this information because I want to see a levelling up of healthcare throughout the country,” he said. “We do need to understand what the differences are in healthcare provision across the country.”

Mr Javid added that GPs had done “phenomenal work” during the COVID-19 pandemic and added: “We want to support them to do what they do best, which is to see patients and to see more patients properly and in a way that the patient chooses.”

The health secretary said the measures will “help GPs to see more people face-to-face and more promptly”.

He stressed patients should have a choice between in-person appointments and remote consultations, saying: “I believe in choice, I think that’s what patients want to see.

“The vast majority of GPs I talk to say that if you can help us to increase capacity, if you can provide us the support, that’s also what we want to do.

“I think patients should have a choice, and if some choose that they prefer remote or online versus face-to-face then that absolutely can be right for them.”

Mr Javid visited a GP surgery in southeast London on Thursday.

Dr Jai Israel, principal GP at The Vale Medical Centre in Forest Hill, told Sky News afterwards that the surgery does not “have the bodies” to increase the number of face-to-face appointments.

“It’s not about the funding or injecting the millions into the service,” he said.

“If the GPs aren’t available, we can’t provide the appointments that they need. The problem that’s happening now is individual GPs are having extra patients on top of their fully-booked sessions.

“This is creating a lot of pressure mentally on GPs, but also it’s unsafe. Because with too many clinical contacts in a day for an individual, there’s a very high risk of clinical error occurring.

“GPs are consistently watching their back, afraid that they may make such a mistake.”

The Great Debate

The NHS said the “winter access fund” will allow GPs to improve the availability of appointments and increase the number of face-to-face appointments and same-day care.

Other healthcare workers will be given new powers to provide patients with medical documents like fit-to-work notes or DVLA checks in a bid to free up GPs.

The NHS said GP practices must “respect preferences for face-to-face care unless there are good clinical reasons to the contrary”.

People will be able to compare GP practices thanks to appointment data which will be published at practice level by spring to “enhance transparency and accountability”, the health service said.

It is not clear how “appropriate levels” of face-to-face care will be defined, but those who do not meet the standard will be offered support to improve.

“Walk-in consultations” could be one of the ways in which practices choose to address the problem.

GP telephone systems will be upgraded to reduce long waits over the phone, social distancing in practices could be changed or reduced, and patients will be able to see nurses, pharmacists, and paramedics at GP practices.

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