Tuesday, June 6, 2023

Helen Salisbury: New telephones, but no one to answer them

The Department of Health and Social Care and NHS England published a report last week about how they intend to improve access to primary care.1 The most concrete elements are funds for new telephone systems and trying to offload some GP work onto community pharmacies. The reception has not been positive, partly because many surgeries are already doing nearly all the things in the plan and are still drowning in patient demand.

Cloud based telephony could count as a small advance: it means that patients, instead of getting an engaged tone, will now learn that they’re 20th in the queue. But our ability to see how many calls are waiting—and for how long—won’t create more receptionists to answer the phone or increase the number of appointments available when patients do get through. It reminds me of a mad, half built road scheme in the town where I grew up, which (after the demolition of many houses) funnelled traffic very efficiently from one bottleneck to a bigger one.

Community pharmacies are apparently going to take on some of the work traditionally done in general practice, and this would be a fine plan if they weren’t as hard pressed as we are. From 2015 to 2022 there was a net loss of 670 community pharmacies in England, with proportionately higher rates of closure in more deprived areas.2 These businesses struggle to stay afloat financially because of funding arrangements from the government, and the ones still operating are run ragged trying to satisfy demand for medicines in the face of endless supply problems. They’re short staffed because so many of their pharmacist colleagues have moved to work in primary care networks and, even if they had the time, many don’t have the skills to take on the prescribing role envisaged for them.

There are some welcome elements to the plan, including cutting the number of targets and tick boxes currently required to claim the funds we need to run our practices. They promise work on the GP-hospital interface to reduce the tasks that flow unnecessarily to us. They also plan to stop deporting doctors from overseas as soon as they qualify if they haven’t yet arranged employment with a practice that holds a visa sponsorship licence—instead, they’ll allow them a whole extra four months to sort this out. Overall, although the word “ambition” seems liberally scattered throughout this document, it could not be called an ambitious plan. Little here will make life easier for patients or doctors.

I do quite like our new phones, although I have fears about future monitoring and interference. But no amount of shiny new tech will compensate for all those years of failed workforce planning.

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