Recent political turmoil has led to the appointment of a new health and social care secretary in the form of Steve Barclay and a new Prime Minister is due to be selected by early September.

When new people come into such influential posts, there is a brief chance to seek their attention and enlist their support. Primary care could benefit from such a window of opportunity to argue for its corner.

Healthcare leaders are wise to this.

Just after the election of the leader of the Conservative Party was slimmed down to two candidates recently – Liz Truss and Rishi Sunak – the RCGP signed a joint statement from the medical royal colleges calling on the candidates to commit to making health and care a priority and, more specifically, to provide the right health and care workforce by increasing medical school places and clinical training places.

They warned of the “long lasting” impact of the COVID-19 pandemic on the general health of the British public and the NHS, highlighting the fact that NHS waiting lists stood at a record 6.61 million.

Pressure on primary care was also a large concern, as the statement pointed out that  general practice carried out almost 370 million consultations last year, with each GP looking after 10% more patients on average in 2022 than in 2015.

So what do practice managers see as the priorities for the health service and primary care in particular?

Public perception

Robyn Clark, practice manager in South Gloucestershire and a director of the Institute of General Practice Management (IGPM), believes tackling the negative views expressed about general practice in recent times should be a priority for the new prime minister and secretary of state.

“I’d say what should be high on the list of ‘must-do’s’ as a priority is ceasing the smear campaign against general practice and actually investing in us, whilst recognising the amazing job we do,” says Robyn.

“They should also be acknowledging we are facing a real crisis and taking tangible steps to address this through adequate funding, reducing bureaucracy and investing in community-based service to support people to continue to live well at home.”

Another good idea would be to come and visit practices to see what really happens, she argues, adding: “I’d say spend time at practices and make sure you see how it works at the coal face – and not just by going to practices that will put on a happy face and try to make it look like everything’s okay. Visit those who are struggling or challenged, or those who will be honest!”

Rob Noel, managing partner at a practice in Swindon, says: “I’d say work on giving general practice some positive PR from the top down, as we have been unjustly and unfairly savaged by previous health secretaries in the press, when it is apparent to us on the front line that they don’t have a clue what goes on, or more worryingly, they are laying the foundations of the Tory plan to scrap general practice and introduce private healthcare.”

Tackling unfair negative perceptions of general practice is also a priority for Jo Wadey, practice business manager in Worthing, West Sussex and IGPM director, who says: “They need to stop GP bashing because that is the only way we are going to continue to retain the staff that we’ve got. They should also be stricter on abuse in practices.

“I’d like to see them try to educate patients that they don’t always need to see a GP and that there is a wider, multi-disciplinary team which is just as skilled. Patients should get the appointment that they need with the person they need and not what they want.”

Workforce

Ensuring there are enough doctors should be a priority, according to a practice manager from Cumbria who wishes to remain anonymous, saying: “We have had a long-standing commitment from all the [political] parties to increase the number of GPs and it’s appalling that no progress has been made against that.

“It seems to be a very simple thing to me. I know it’s got a cost attached to it but the medical schools have a quota and there’s no shortage of applicants. That means there’s plenty to choose from so all that needs to happen is the cap needs to be lifted.

“If we are serious about solving this problem, that seems to me to be a solution – give all the medical schools a 10% increase on their student numbers cap. That will take a while to come through because of the time it takes to train doctors.”

Dispensing

The manager from Cumbria is also keen for all GP practices to be allowed to dispense and give patient choice as to where they get their prescriptions from.

“We are in a fortunate position in that we dispense to 90% of our patients and the income from that bankrolls one full-time GP,” they said.

“I know that not all practices would want to dispense because of staffing or space constraints, but if we said we would let patients choose where to take their prescription from and let any doctors’ surgery which wants and is able to dispense and is capable of doing it safely and well, that would switch money out of the for-profit pharmacy sector and bring that money into primary care and wouldn’t cost the taxpayer a bean. The injection of cash into primary care would let us do all sorts of things.”

Funding and resources

Funding of primary care is an inevitable topic for discussion, according to practice managers and Rob says: “Top of the list of must do’s is to significantly increase the budget given to primary care, as we see 95% of all patients compared with secondary care, and have just over 9% of the entire NHS budget.

“If the government is truly invested in wanting to make ICS’s [integrated care systems] and PCNs [primary care networks] work, funding at the current rate is setting primary care (and in particular general practice) up to fail.”

Pay is an issue, Robyn agrees, saying: “They need to stop making it [recent pay awards announced] sound like it applies to all NHS staff – because it doesn’t apply to us. When they award an increase higher than what we had in our uplift, they need to agree to revise our uplift to make it align.

“We are too often being treated like the poor cousin when we are actually representing the best value for money in the entire health sector.”

The manager from Cumbria adds: “We are on a slow, gliding path to reduced practice income. Those monies are coming back in through the PCN mechanism but the PCN experiment has had variable success around the country.”

Extra workload

Growing waiting lists for hospital appointments and procedures has also impacted on primary care, as the Cumbrian manager explains: “We are seeing a load of people coming in here that we are having to manage in the period before they are able to get their referral.

“During the additional time that they are waiting to be seen in hospital, they are not just sitting at home quietly waiting, they are in and out of here much more than usual. In some cases, we are having to manage conditions in primary care that would ordinarily be managed in secondary care.

“I have got GPs who are managing cancer patients through the cancer treatment process. Clinically, they are doing things that are outside of their normal remit and are having to push their clinical skills. There is a safety aspect to that. They will only do that when they are comfortable to do so and they get advice and guidance from the hospital to help manage the patient.”

One good idea being put forward to ease pressure on practices is to look again at QOF, as Rob says: “I would suggest scrapping QOF and increasing the GMS contract accordingly. This will stop us in general practice from having to focus on the ‘flavour of the month’ long term condition (LTC) and enable us at practice level to allocate funds to care more effectively for our local population and focus on LTCs that affect them rather than a decision made at NHS England level adopting a ‘one size fits all’ policy, which does not work.”

The new Prime Minister and secretary of state look set to have an overflowing inbox awaiting them.