The recently published document ‘Our Plan for Improving Access for Patients and Supporting General Practice‘ needs no introduction. It has caused an angry reaction from general practice, which now teeters on the verge of industrial action. Above all, the document represents a failure of leadership from those charged with providing it for the service.

For many years, these very same leaders have been pushing general practice to increase the number of telephone and electronic consultations they offer. The aim of this was always to try and improve access to general practice. Covid came, and the wish of the government was all of a sudden granted.

Once the Covid restrictions eased, this new way of working meant (despite the lack of available workforce to deal with the capacity) practices could use this newly established means of accessing care as a way of effectively managing demand. Practices can consult virtually or on the phone with those patients where that’s all that’s required, and protect the face-to-face capacity for those who really need it.

Covid has presented this huge opportunity for practices to work in a different way, based on exactly the change that NHS England and the government have been pushing for many years.

But, of course, people don’t like change. There are a significant cohort of patients who are used to being able to see their GP whenever they choose to, and this new way of working means this is no longer the case. Face-to-face access is based on clinical need, not patient discretion. As a result, despite the overall patient experience being improved (as shown by the recent GP survey results) and patient needs being better met, some patients who are unhappy with the change are complaining. These complaints go to whoever will listen, including the national media.

What, then, should the response of those in government and in national leadership roles be? It should be to educate the public, to reinforce the value of the new way of working, to articulate the benefits this model brings to all, and to ask everyone to play their part. It should be to support practices who have made the change, so that the service (under-resourced as it is) can better manage the ever-growing demand. It should be to enable the NHS to continue to meet its three core principles: meeting the needs of everyone; being free at the point of delivery; and being based on clinical need, not the ability to pay.

But what response did those in government and national leadership roles provide? A message that patients should decide if they need to be seen face to face or not. That we should have a system based on caring for those who shout the loudest, that prioritises the needs of those most capable of using the system.

Not only does this go against the NHS’s core principles, it has created patient expectations that practices cannot possibly meet. This in turn has resulted in the rise in violence and abuse towards general practice staff that we have seen in recent weeks. Londonwide LMCs reported that, “a recent straw-poll of London practices found over 9 in 10 (94%) are experiencing violence or abuse from patients, with 3 in 10 reporting over 20 incidents over the past three months”. It’s the same elsewhere in the country.

The leadership response should have been to dampen expectations and prevent the abuse in the first place. Instead, it chose to stoke them up, and then (to add insult to injury) to offer to pay for the security cameras that are only required because of their own actions.

It all amounts to a failure of leadership.

The anger in general practice right now is palpable. In this month’s Practice Index Practice Manager Panel podcast episode, we get a taste of that anger as our panel give their own reactions to the document and its impact on practices.