11th August 2016

Dear Mrs May

Firstly, may I congratulate you on your appointment as Prime Minister. I now wait with baited breath for Mrs Clinton to become President and we will have three strong women in power! (About time too!)

I write to you in my capacity as a Practice Manager working in Primary Care, a role I have had for over 20 years (albeit working in different surgeries) with a career of over 30 years in General Practice – so, I’d like to think that I’m talking from a position of relative authority!   Unfortunately, various Ministers of Health over the years have seen fit to ignore Primary Care – or rather, choose not to listen to those of us working at what is best described as the ‘coal face’ of the NHS.

I do not wish to try and teach you to ‘suck eggs’ – but I would like my voice (and that of my colleagues) to be heard – something that has sadly not happened before. You are acutely aware of the abysmal financial position that we face; the fact that many GP surgeries around the country are closing due to a lack of support, or difficulties they are having with recruitment and retention of GPs. You are also aware that some Clinical Commissioning Groups have started off the financial year heavily in debt with no chance of cutting their expenditure to allow them to balance their books by April 2017.

I am not offering a miracle cure, nor would I dare to suggest to you or your Minister for Health on what should be done. However, I believe that some small, but significant, changes could improve the financial position, without detrimentally affecting care – which after all, is our over-arching concern.

Prescribing:   Let’s stop providing medication that is available over the counter at pharmacies and supermarkets. For example, if we stopped prescribing Paracetamol we could save over £8million per year. Now, there are a number of people who use paracetamol as an effective pain-reliever and we couldn’t expect them to buy 16 tablets every 2 days from the supermarket – but a locally agreed policy with a named pharmacist to dispense larger quantities by agreement with the patient’s GP would easily get round this.

The same applies to Paracetamol Suspension, Ibuprofen gel – the list is almost endless.

Prescription Charges for Medically Exempt Patients: Certain patients receive medication free of charge if they have a condition such as diabetes. Now, we should absolutely ensure that they have their diabetic medication/insulins free, but if we prescribe an antibiotic because they have a chest infection for example, why do they get this free too? This has nothing to do with their diabetes!

CQC Inspections and Registration:   You may be aware that this year we have seen a rise in our fees for registration with the Care Quality Commission by over 200% with a further increase over the next two years. I understand that there is a move to reimburse practices for this, but this has not yet happened, nor do we have a timeline for this. Many practices, mine included, struggle with cash flow on a monthly basis. To find that our fee has risen from just over £600 to over £2100 purely for registration with the Commission is just not acceptable. We have paid the fee, because we dare not risk the consequences – but this additional outgoing, without recourse to reimbursement, has put many of us at risk.

We all appreciate the need for this body to exist but we don’t appear to be getting much back in return for the fee.

I would also like to draw your attention to the overly bureaucratic process that is the inspection. Each surgery would have between 2 and 5 inspectors visiting on one day. The inspectors would already have received vast quantities of paperwork supporting individual protocols and policies that we have in-house, yet still the need to visit the surgery in what has been described by some of my colleagues as a heavy-handed approach. I do not know what inspectors charge for their expenses, but I am aware that 118 CQC officials inspecting Dorset Healthcare Foundation Trust in Poole incurred expenses of over £80,000 for one single inspection.

The 2004 contract for Primary Care (which included the Quality and Outcomes Framework) was ‘sold’ to us as “high trust, low bureaucracy”.   From where I’m sitting, there is little trust and enough paperwork to fell a large forest.

It is disheartening to read that surgeries are closing because they feel unsupported or they just cannot manage with the resources they have to provide the service their patients need.

We must stop expecting clinicians to be managers. It is time the Government talked to those of us in Primary Care who manage the system; we are the ones who can help shape the future and at the very least, provide input into those parts of the system that could be improved and ultimately be more efficient (and cost effective!). I am a passionate supporter of the NHS, but fear that it has an expiration date, unless we radically alter how we work.

I have tried desperately to get your Ministers to listen but have failed, so now I’m going right to the top in the hope that you might be able to change that. I would like the opportunity to sit round the table with key members of your department, and a few of my peers to give you the information that you will need to help get Primary Care back on track.

I hope that you will give this due consideration and await your response.

Yours hopefully,

Nicola Hayward

Practice Manager and Optimist