As winter approaches and GP practice workload spirals upwards, practices are now facing another new target over how quickly they should be seeing patients.

During her brief time as health and social care secretary, Thérèse Coffey announced that GP practices would be expected to meet a target of booking all appointments within a fortnight of patient requests.

Coffey’s plan is still in place and is official government policy under the latest incumbent as secretary of state – Steve Barclay – with data on how practices are doing due to be published from this month.

This was announced as part of the government’s Our Plan for Patients strategy which says:

• there is an “expectation” that everyone who needs an appointment with their practice within two weeks can get one
• an additional 31,000 phone lines will be made available for GP practices
• data will be published on how many appointments each GP practice delivers and length of waits for appointments
• ICBs will be required to “hold practices to account” to improve performance.

From later this month (November 24), NHS Digital will be publishing “easy-to-use” data showing exactly how many appointments each practice in England is delivering and how long people wait between booking an appointment and receiving one.

Reaction

Unsurprisingly, the target has not had a warm welcome from practice managers.

Karen Steer, HR & Operations Manager at a practice in Norfolk, says: “It is a bad idea because we don’t have the capacity in the already bursting system to promise an appointment within two weeks with a GP.

“The demand has gone mad since the pandemic and we simply cannot cope with it. Adding more stress into the bargain with unachievable and unrealistic promises from people who don’t know anything about the shop floor is just asking for trouble.”

A practice manager from West Essex, who wishes to remain anonymous, says: “I think it’s wrong to put rigid targets on GPs which will have no effect on patient outcomes. Naming and shaming GPs is the last thing that they need. I think it’s completely unhelpful and I don’t think it will have any beneficial effects.

“Until the government fulfil their stated objective of recruiting another 5,500 more GPs, any such target is just misplaced and misguided.”

Extra staff

One of the justifications for the strategy from the government is its promise to relax funding rules to allow a broader range of staff working in general practice, such as more GP assistants and advanced practitioners.

Practice managers are not convinced, arguing that even if there were additional ancillary staff to help ease the workload on doctors, this would not solve the problem by itself.

Nicola Davies, a practice manager in Cornwall and co-founder of the Institute for General Practice Management (IGPM), says: “Thérèse Coffey said the government contribute money to employ other people to get these waiting times down. Our response is ‘but there are no people out there who want the jobs’.

“The government response is to throw money at it, but the reality is you can throw as much money as you want at this, but if I haven’t got the bodies, it won’t work.”

The anonymous manager says: “If they cut the bureaucracy and address the estate issue and IT issues, then ARRS (Additional Roles Reimbursement Scheme) roles can help. Until they address those three things, most PCNs [Primary Care Networks] are struggling with increasing their ARRS compliment.”

Karen adds: “We are trying to promote alternatives to a GP that are more sensible, for example physio for MSK (musculoskeletal) issues, pharmacists for medication issues, nurse practitioners for acute issues who can prescribe and deal with patients as effectively as any doctor can.

“This frees our GPs to do the stuff that only they can do. It’s using common sense, something severely lacking in the higher powers I feel, to deal with the situation in a way that is sustainable.”

Alternative targets

Whether the new target is the right or wrong one or whether an alternative objective would be more useful is missing the point, according to the manager from West Essex, who says: “Unless you are going to back it up with proper resource and proper action, the [target] is just political window dressing.

“I think people should be saying enough is enough and we are not having this. It is wrong and it’s adding to the GP witch-hunt agenda. It is implicit that they are saying the problem is lazy GPs who are not seeing patients and we know that is just not true. It is immoral to imply that and will lead to more aggravation and abuse of practice staff.”

Sophisticated data

Once the new data begins to be published later this month, managers are curious to see how sophisticated it will be and whether or not it will tell patients the full story – such as whether a patient was offered an appointment within a fortnight but refused it because they insisted on seeing a specific GP.

This new data could reignite the unforgiving media spotlight on GP performance.