This week, NHSE have released their Delivery plan for recovering access to primary care along with a covering letter.

Well, dear readers, I’ve waded through it, as I’m sure many of you will have done, and I’ll admit to being a bit confused. As is common of late, many of the announcements and ideas that have been published are things that have already been announced. Indeed, there’s plenty of funding mentioned that was already earmarked for other things, and this has been re-purposed to look like it’s new money.

The Institute of General Practice Managers (IGPM) have written a response to the Delivery Plan. The plan runs to 40 something pages and the IGPM have done well to keep their response to three. I could write a book on my feelings about the plan!

Of course, anyone could write a business plan that says “I’m going to sell three million units this year”, but that doesn’t mean it will happen. What the NHSE delivery plan seems light on, is detail. We’ve been waiting for what seems like forever for this document, hoping that it will hold the answers to our questions. As ever, though, the plan doesn’t deliver on the detail, and this document points to other documents, which haven’t yet arrived, for further clarity. Are you spotting a pattern here?

The plan mentions empowering patients, implementing Modern General Practice Access, building capacity and cutting bureaucracy.

In short, it says:

• Patients are to increasingly use the NHS app and, for some things, they will be able to self-refer where no clinical input is needed, and patients can go to the pharmacy for some prescriptions.
• There will be better phone systems and assessment of need on the day. Patients are to be seen within two weeks. I’m not sure why they think there’s a magic way of making this work; if there was, we’d be doing it already.
• There’s a focus on support and training, including digital resources, for a move to care navigation. I think we’re already doing a pretty good job in this area. Some of the other issues raised in the plan, like the primary/secondary care interfacing and the lack of doctors, point to why we have issues. Perhaps things will improve if we have somewhere to direct patients to? I’m not sure that training for 6,500 people is going to cut it, though – it seems this figure will cover one staff member per practice at best.
• Online requests are to be simplified. I contact my own GP using the NHS app, so I agree that this should be the way forward. My issue, though, is the narrative that’s being spread that we’re not seeing patients. To put this straight, we are and always have been. NHSE are happy to say “digital first”, but in the same breath, they talk about recovering access. I don’t think patients know what the difference in approach is, and the narrative isn’t helpful.
• They aim to increase the workforce, making reference to the Long Term Workforce plan which is due to be published. This is what I mean about the detail; it’s still not there! So how are we going to take action when the information we need is missing? There’s emphasis on the wider team, which is surely about ARRS roles, but not all of us are finding these roles easy to recruit for. More new GPs and keep existing GPs? This hasn’t worked for years, and I’m not convinced there’s any real incentive for GPs to remain in practice. And when, every day, primary care is being thrown under the bus by the media, recruiting new staff isn’t easy.
• There’s to be an increased emphasis on primary care in terms of planning for new housing. Awesome. Where are we going to get the staff from then to fill these new developments?
• Improving the primary/secondary care interface is mentioned. I’m totally behind this. There are so many moments when you wonder why on earth things don’t make more sense. Patients who are in a never-ending loop of referrals and re-referrals will hopefully be a thing of the past. I can only dream of the day when discharge medications, summaries and sick notes are all dealt with on discharge by secondary care, and not sent to the GP to action. This is the stuff that makes you wonder why it wasn’t put into practice years ago. Recalls run by the teams that want the information – marvellous, everyone gets what they need in a timely manner.
• Then there’s cutting bureaucracy through the Bureaucracy Busting Concordat. What is a concordat?! I’m least convinced by this one, as the title sounds a little…erm, bureaucratic? Apparently, this guidance has been in place since August of last year and some of its work has been seen as early as 2020. So, I’m dubious about the number of “quick wins” we might see from this one.

Some of the support outlined is re-purposed money; some is stuff we already know about and are working on; very little is innovative or new to general practice. Some of the financial support outlined is clearly going to be targeted at the practices with the biggest journeys ahead, which means that the rest of us will be left to our own devices. Re-purposing money from the budget doesn’t mean we now have new money; it just means we can’t necessarily spend it on the things we’d expected to.