Teesside health chiefs respond to lack of GP appointments

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PATIENTS frustrated about not being able to see a doctor have been told the “tide is changing” and they are just as likely to be offered help by other GP practice professionals.

Karen Hawkins, a director of commissioning, strategy and delivery at the Tees Valley Clinical Commissioning Group, said high quality patient care no longer relied solely on the “traditional model” of GP delivery.

The organisation’s governing body was put on the spot at a meeting by a member of the public, who described how not being able to get an appointment with his doctor was “scary”.

Teesside pensioner Ron Dennis relayed concerns about some GPs working from home and suggested those that were working part-time should be asked to increase their hours.

He also said the availability of GP appointments was “way below what it should be”.
Mr Dennis said: “The vast majority of patients are expecting an appointment with their GP.

“The availability of patient appointments with GPs has been decreasing and demand is exceeding supply.

“I would expect practice managers to always ensure that supply is greater than demand or at least equals it.

“I can’t understand at a time when demand is exceeding supply why managers aren’t looking at their part-time employees and expecting them to put in more work hours.

“You can’t magic a new GP, but you could look at part-time GPs and ask them to work more hours, it seems to me that is not happening.”

Mr Dennis described how he rang his surgery for an appointment with his GP and was told nothing was available for the next fortnight as all the slots were full.

He said: “I find it scary to be honest.

“The availability of GPs is way below what it should be.”
In terms of GPs working from home, he added: “An appointment with a GP – so a meeting with two people – can only take place at the surgery, only a consultation can take place online.

“The fact that some GPs may be working from home, which makes them unavailable for appointments with patients, is a concern.”

Mrs Hawkins said more than 12 full-time equivalent GPs had been lost in the region’s primary care sector between 2018/19 and 2021/22.

But nurses roles and what she described as “direct patient care roles” had increased over the same period with more than 207 full-time equivalents being added.

She said: “Across the Tees Valley we have 80 practices and over the last two years teams have been changing in terms of numbers and composition.

“More care is now delivered not only by GPs, but with a multidisciplinary team approach – a group of professionals, which includes GPs but also nurses, pharmacists, physiotherapists, mental health practitioners, just to name a few.

“The tide of change in terms of this way of working is unlikely to be reversed now and it will undoubtedly gain momentum during the next few years.

“That is to address increasing and challenging demands that are not only placed on healthcare services generally, but demands within primary care that have intensified and become more complex in relation to treating patients.

“To ensure high quality patient care it does rest on the diversity of teams, their skills and experience and the wide range of health professionals within practices, and not solely on the traditional model of GP delivery.”

The CCG does not employ GPs, but holds contracts with their practices so services can be delivered to the public.

Mrs Hawkins said practices were regulated by the Care Quality Commission, who considered staffing levels.

She also said patients did not always understand how GP services were now being delivered and did not have the confidence to contact a surgery to say, for example, they needed to see a mental health practitioner 

She said: “They are not sure what they do, they are not sure what the clinical pharmacist does, or the physios within practice.

“We need to look at this as we move forward to try and ensure and reassure patients around the skill mix working in primary care and make sure they feel confident in terms of the offer they are being provided with and seeing the right person for the right need with the right skills.”

Mrs Hawkins added: “We have seen a significant increase in demand for practice and GP services over recent months, but GPs are delivering services and will continue to deliver services.

“There are new ways of consulting with patients and there is a significant demand now for e-consultations and video consultations, and GPs and other staff can undertake those remotely as they did through the covid period.

“There still is the requirement for GPs to see patients face to face when it is clinically necessary and each practice will determine who is the most suitably qualified person to see each patient based on their needs.

“We are working with practices across the whole of the Tees Valley to ensure we are able to improve access for all patients with new consultation methods and ways of working within practice.”

‘Slow pace’

The same meeting was briefed about a recent public consultation undertaken by Healthwatch Hartlepool, an independent group which represents the interests of patients using health and social care services.

Its findings highlighted the slow pace at which face-to-face GP appointments were being introduced following the covid-19 pandemic.

Healthwatch Hartlepool said many patients experienced difficulties when trying to arrange appointments, particularly by telephone, with the situation “particularly problematic” for people with disabilities and working age adults.

It also said virtual or telephone consultations posed problems for some individuals and it was “sure the findings are reflected in other parts of the Tees Valley and highlights the necessity for improved access to GP services”.

The chairman of the CCG’s governing body, Hartlepool GP Dr Boleslaw Posmyk, told Mr Dennis he understood that it was worrying when people could not get the appointment they needed.

He said: “All your comments are noted and we will reflect on those.”
Dr Posmyk said GP’s way of working had “changed radically” since he joined up in 1986 and there was now more emphasis on having a mix of skills in surgeries.

In February this year Dr George Rae, who is chairman of the North-East British Medical Association, told the Local Democracy Reporting Service that the pandemic had accelerated a change in healthcare with a “digital revolution” taking place.

He said: “This is something that will not change, it is the way things have moved on.

“Of course there has to be face to face appointments, but with the digital has come more triaging, which was there before the pandemic, and is not a bad idea at all to enable a judgement call to be made.

“It is all about ensuring that there is prioritisation and the people who do need to be seen face to face will be seen face to face, that is the right of everybody.

“The younger generation perhaps accept a digital conversation, the older generation, of course not having been brought up this way, are more ingrained towards face to face.”

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