Laughing GPs mock ‘frit’ Sajid Javid as Health Secretary pulls out of union’s conference

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GPs have mocked Sajid Javid after the Health Secretary pulled out of a union’s annual conference amid a bitter row over the lack of face-to-face appointments.

Mr Javid last night unveiled a revolutionary plan to name and shame doctors that fail to deliver enough in person appointments.

The nine-point plan also included a £250million uplift for family doctors to help them cope with winter pressures.

But amid anger at the proposals the Health Secretary pulled the plug on plans for him to speak at the Royal College of GPs annual conference in Liverpool.

Dr Michael Mulholland, the vice chairman for professional development at the college, announced the change in the schedule to a laughing conference hall.

‘Unfortunately we have one change to the programme. The Secretary of State for Health for England is unable to join us today either in person or by video link.

‘This is because, and I need to get this right, he had to “clear his diary to ensure he can fight for the NHS in the spending review, or be anywhere else you may have seen or heard from him this morning”.

‘As I said before, we did not start this fire.’

Mr Javid was set to send a pre-recorded message to the conference, which would have been shown at the opening session this morning.

England’s chief medical officer Professor Chris Whitty attended the session, where he praised GPs for their hard work throughout the pandemic. He admitted the current level of face-to-face appointments was ‘not where it needs to be’.

The Health Secretary today visited a GP surgery in south-east London, where he praised the ‘amazing work’ of GPs in fighting Covid and seeing patients.

In a round of media interviews this morning Mr Javid defended his proposals, saying they would help GPs to do what’s best and see their patients. Doctors will now only be able to refuse a face-to-face appointment if there is a good medical reason.

But GPs blasted the plans as ‘insulting’ and accused Mr Javid of being ‘frit’ for pulling out of the conference. Unions warned they could trigger a wave of retirements from the profession.

Dr Richard Vautrey, of the British Medical Association, said he was ‘hugely dismayed’ with the package. He added: ‘It offers very little and shows a Government out of touch with the scale of the crisis on the ground.’ 

The plans are a victory for the Mail’s Let’s See GPs Face to Face campaign. The Health Secretary, Boris Johnson and new NHS chief Amanda Pritchard all paid tribute to the Mail for highlighting the devastating decline in face-to-face appointments.

It came as the NHS waiting list for routine hospital treatment in England hit another record high today, with 5.7million patients now stuck in the queue. 

Visiting the Vale Medical Centre in Forest Hill, Lewisham, Mr Javid was told by two doctors that they were facing the same number of appointments as in March last year. 

Dr Ali al-Bassam said the only difference is how people have their appointments, adding that around a third are face-to-face while the rest are on the telephone.

Dr Clementine Olenga-Disashi said doctors have been working ‘harder’, to which Mr Javid agreed.

‘I’ve seen that in similar practices across the country, the demands from the pandemic as well as the vaccinations — whether it’s a patient here or in a care home — it’s all new demand that wasn’t there,’ he told them.

He added that part of the health department’s plan is to try to help support doctors by getting pharmacies to do ‘a bit more’ for patients with minor illnesses.

‘We’re trying to get rid of some of the red tape,’ he said. ‘A lot of GPs have been talking about fit notes, for example.’

Official figures show fewer face-to-face GP appointments are being carried out now than before the pandemic.

Statistics for England from NHS Digital show only 58 per cent of GP appointments in in August were held face-to-face. 

This is well below levels seen before the pandemic struck, when 80 per cent of consultations were carried out in-person. 

But campaigners fear the data may have been ‘fiddled’ after it emerged that some phone consultations are being wrongly recorded as having taken place in person.

Professor Whitty received a standing ovation after speaking at the annual conference this morning.

He told GPs they had been ‘outstanding’ during the pandemic, adding: ‘I’m massively admiring of what all of you have done, and continue to do, in the biggest public health challenge in our professional careers.’

But he added that there were not enough face-to-face appointments being carried out.

He said the Covid pandemic had caused a ‘painful gear change’ in the opposite direction. 

‘Now the pendulum is already swinging back and it will need to come back to a point that isn’t quite out where it was in the middle of Covid, nor is it where it was in August 2019.

‘I don’t think it’s settled at the right point yet.’

He added that the profession has got to ‘have a debate with the public who we serve’ and work out the right balance.

In a round of interviews this morning Mr Javid defended his plans.

He told Sky News: ‘I think it is going to help because it will provide more support, financial support, remove red tape, spread the workload and provide more direct support to practices that ask for more expert advice.’ 

He added that patients should have a ‘choice’ between a face-to-face or remote appointment.

Under the new proposals, GP surgeries are set to only be offered funding if they see enough patients face-to-face.

But asked today what proportion of appointments will need to be face-to-face to secure the extra cash, Mr Javid was unable to give a specific target.

He told BBC Radio 4 that CCGs — which manage groups of surgeries — would suggest which surgeries should get additional funding.

‘My only target is that people have a choice, have a preference,’ he said.

There are also plans for data on the performance of each individual surgery to be published.

Asked whether it would lead to GP league tables, Mr Javid denied this.

He said: ‘We won’t be publishing any league tables. 

‘What the Government will be doing is publishing more and more information, more and more granular information, that will be practice by practice. 

‘The point will be to compare one surgery with another.’

The decision to publish the data practice by practice was taken a few years ago. The NHS has been running a pilot of the scheme and found it was successful.

Mr Javid also thanked GPs for their work throughout the pandemic.

‘I just want to thank… all GPs for the phenomenal work they are doing, especially during the pandemic,’ he said.

‘What this package is about today is what support can be provided by the Government, by the NHS, so that more patients can be seen more promptly in a way that patients choose.’

Responding to the plan GP Dr Jess Harvey said it was ‘insulting’ to be told she had been ‘underperforming’.

She told BBC radio 4: ‘General Practice is on its knees. 

‘I do not know anybody in General Practice right now who is not working their knuckles to the bone, and frankly for Mr Javid to describe us as underperforming is insulting. 

‘I would invite him to come and see what we’ve done, to come and see what I do on a daily basis, and to show me where I am underperforming.’

She added: ‘The more I read and hear about this proposal the less I think this Government understands about General Practice, how it is run and to be honest the less in touch they are with what is going on in the real world of the NHS and what we’re facing.’

British Medical Association GP committee chair Dr Richard Vautrey warned the plan could lead many doctors to ‘hang up their stethoscopes’.

He said: ‘It’s truly frightening that we havea Government so ignorant to the needs of such a core part of the NHS.

‘GPs want to improve the care we offer our patients, but today’s offer will not enable us to do that as we had hoped.

‘GPs across England will be truly horrified that this is being presented as a lifeline to General Practice, when in reality it could sink the ship all together.

‘There can be no doubt that this lack of action at sucha critical time will force many GPs to hang up their stethoscopes and leave the profession for the last time.’

Dr Michael Mulholland, vice chairman for professional development at RCGPs, announced today that Mr Javid would not be attending the annual conference.

To laughter from the audience, he said: ‘Unfortunately we do have one change to the programme. The Secretary of State for Health for England is unable to join us today either in person or by video link.

‘This is because, and I need to get this right, he had to “clear his diary to ensure he can fight for the NHS in the spending review, or be anywhere else you may have seen or heard him this morning”.

‘As I said before, we didn’t start the fire.’

Britian is currently facing a shortage of GPs, with their numbers falling by 4.5 per cent across England in five years.

In 2015, the Government promised to hire another 5,000 GPs over the next five years.

But NHS data, analysed by the Royal College of GPs, showed there was the equivalent of 28,096 full-time GPs in March 2021. This was down from 29,403 in September 2015. 

More and more GPs are retiring in response to the mounting workload, with a lack of training incentives meaning there are few doctors available to replace them.

Mr Javid said a record number of students have entered medical school to train as GPs, but these will not be in practices for years.

Under the new proposals, patients will be given the right to demand a face-to-face appointment with their family doctor.

GPs will be told they should refuse a plea to have an in-person consultation only if there are good clinical reasons.

The NHS England ‘Plan for GPs and Patients’ will give practices £250 million of extra cash to take on more staff, ensuring patients can have an appointment on the day they request one. This could include extending opening hours.

But they will not be able to access the extra money if too many of their consultations are carried out over the telephone or online.

New ‘transparency’ rules will also publish data on the level of service offered by individual GP practices, including the level of access for patients seeking face-to-face appointments.

Whitehall sources acknowledged the data would allow the creation of local and national league tables, with the worst performers named and shamed in the media.

GP practices which fail to improve access for patients will face direct intervention from teams of NHS trouble-shooters.

To help doctors improve their service, red tape will be slashed to give GPs more time to see patients in person – and telephone systems will be upgraded to make it easier to book an appointment.

Meanwhile, pharmacists will get enhanced powers to treat a wide range of minor complaints to ease the pressure.

The Department of Health will reduce administrative burdens on GPs by reforming who can provide medical evidence and certificates such as fit notes and DVLA checks – freeing up time for more appointments.

And officials will today confirm that GP surgeries can scrap the two-metre social distancing rule imposed during the pandemic, which has dramatically reduced numbers in waiting rooms.

However, last night there were signs the plans would spark a row with doctors’ unions and some frontline GPs.

Dr Richard Vautrey, chairman of the British Medical Association’s GP Committee, said the proposals would make appointments harder to book and the Government was ‘out of touch’.

He said it was disappointing to see there was ‘no end in sight to the preoccupation with face-to-face appointments’ – and demanded an end to ‘target-driven, payment-by-results’.

Professor Martin Marshall, chairman of the Royal College of GPs, said there was ‘nothing here to address the long-standing workforce pressures facing general practice’.

But he cautiously welcomed plans to slash bureaucracy. ‘GPs go into medicine to care for patients, yet they spend a significant amount of their time on box-ticking and filling forms,’ he said.

‘This bureaucracy has an impact on workload in general practice, which has become increasingly ‘undoable’ and is leading to many GPs, and other members of the team, burning out or leaving the profession.

 Last night the Prime Minister praised the Mail for highlighting the collapse in face-to-face appointments over the past two years.

Mr Johnson said: ‘The Mail’s campaign on this issue has shown the importance of everyone having the choice and ability to see their GP face to face, and this plan will mean more appointments at more surgeries.’ Writing for the Mail, Mr Javid said he was determined to get the NHS ‘closer to pre-pandemic levels of face-to-face appointments’.

Mrs Pritchard thanked the Mail for acting as ‘a strong voice for patients’, adding that there would also be a new effort to tackle abuse against GPs.

The nine-point plan came as a YouGov poll found that two-thirds of people prefer a face-to-face appointment.

The Nine Commandments…and what they really mean

By Shaun Wooller for the Daily Mail 

The Daily Mail launched its campaign to improve access to GPs after being inundated with horrifying stories from readers who struggled to be seen in person.

The revolution it has brought about is an extraordinary achievement that will undoubtedly benefit patients and the NHS. Today’s new NHS England and Department of Health blueprint will help ensure all five points of the Mail’s original manifesto for change are delivered.

It will improve access to GPs, get patients and doctors back into face-to-face contact more often and boost safety.

Here are the nine key points of today’s announcement – and what they mean:

1 Patients’ right to face-to-face appointments

What they’re announcing: Health officials have made it clear that every GP practice must ask patients what form they would like their appointment to take.

What it means:

Doctors must respect preferences for face-to-face care unless there are good clinical reasons to the contrary – for example, if the patient has Covid.

This means surgeries can no longer fob people off with a remote consultation if they want to be in the same room as their medic.

People can still choose to have their appointment on the phone or by video if it is more convenient.

Conducting appointments in-person will allow doctors to spot symptoms they could not have detected remotely and improve the patient-doctor relationship.

Elderly and vulnerable patients who lacked the technology needed for remote consultations or struggled to use it will no longer feel excluded.

2 More money for more appointments

What they’re announcing: A £250million winter access fund will let practices offer more appointments so patients who need care can get it – on the same day, if needed.

What it means:

The money will pay for locums and other health professionals, such as physiotherapists and podiatrists, with a focus on increasing capacity.

Surgeries will be encouraged to extend opening hours or operate walk-in clinics, making it easier for patients to be seen quickly at a convenient time.

3 ‘Hit squads’ and cash penalties to keep GPs on track

What they’re announcing: GP practices that fail to improve access will face special measures and be denied a share of additional funding.

What it means:

Poor performers will see specialist ‘hit squad’ teams sent in to knock them into shape.

This should ensure patients have access to good quality care. Denying surgeries that fail to improve access a share of the new pot of cash will act as an incentive.

4 Better phone systems

What they’re announcing: The NHS will help practices upgrade telephone systems to make it easier for patients to book appointments and cut waits to speak to a receptionist.

What it means:

New technology will make it easier for staff to manage queues. This will reduce the frustration of trying to reach a surgery, with some people dialling hundreds of times. 

Patient groups report some elderly people have given up attempting to see their GP because of the stress of phoning.

5 Less paperwork and more help from pharmacists

What they’re announcing: The Government will free GPs from some red tape by reforming who can provide medical evidence and certificates, such as fit notes and DVLA checks. Pharmacists will become the first port of call for most minor illnesses.

What it means:

Lessening the burden of paperwork will make the job more attractive and help bring in more trainees, in a boost to the commitment to recruit 6,000 more GPs.

Getting highly-skilled nurses and pharmacists to perform some checks will free up GPs for more complex issues.

Pharmacists will be given greater powers to write prescriptions and treat patients for routine conditions.

6 Relaxation of guidelines on social distancing

What they’re announcing: The two-metre social distancing rule, which applies in surgeries, will be axed.

What it means:

GPs have argued that strict Covid rules prevent them from seeing more patients in person because their waiting rooms are too small to accommodate them.

7 Performance league tables

What they’re announcing: GP appointment data will be published at practice level by spring next year to enhance transparency and accountability.

What it means:

Naming and shaming individual GP practices that fail to offer enough face-to-face appointments or that have long waits to be seen will incentivise doctors to improve. 

Producing league tables will allow patients to compare their practice with others in their town and increase competition.

8 Easier patient feedback via text message

What they’re announcing: Making it simpler for patients to rate their practice’s performance.

What it means:

This will give doctors and NHS managers a clearer picture of what patients do and do not like about their surgery and make it easier to identify recurring problems, so they can be improved.

9 Zero tolerance campaign on abuse of NHS staff

What they’re announcing: A new campaign to reduce abuse and punish offenders.

What it means:

Unacceptable behaviour by frustrated patients drives much-needed doctors out of jobs and creates an environment that is not attractive to new recruits.

Ministers and the NHS hope a new campaign will prevent a disastrous exodus of staff and ensure more medical trainees want to work in general practice.

The Mail’s right. Patients must be able to see their doctor the way they want and now they can

By Sajid Javid for The Daily Mail

Like many Asian parents, my mum always wanted me to be a GP.

When I told her I’d been made Health and Social Care Secretary, she said: ‘Well, you didn’t quite make it to GP, but at least you’re working in healthcare!’

In truth, she was only half joking. There’s a reason why people such as my mum have such high regard for GPs: their powerful blend of expertise and empathy has made generations of communities happier and healthier.

So I want to say a huge thank you to GPs and their teams across the country for their commitment to patients during the most challenging of times.

I may not have become a GP, but I do want to make it easier for them to do their vital work.

Equally, I am committed to making sure patients can see their GP in the way they choose and have a better experience when they do. The Mail has run an important campaign on this issue.

Working closely with the NHS, we’ve made a plan for GPs and patients to do just that: it will mean more appointments in the ways people want.

While I’m determined to get us closer to pre-pandemic levels of face-to-face appointments, it is, of course, true that online and telephone consultations are more convenient for many people.

There’s no question that telephone and video calls will be a part of the future of general practice. But it cannot be the whole future.

With winter just around the corner, I know GPs are under real pressure: the demand for appointments is high and so is their workload.

So today, I’m announcing a fresh £250 million investment in general practice to boost capacity ahead of the winter, opening up more appointments.

With this money, we will expect GPs to provide clear plans for how they will improve access and deliver more face-to-face appointments, such as offering appointments on evenings and weekends.

By and large, people understand why it’s been a difficult time for our GPs: Covid pressures, concerns about infection and reduced space in waiting rooms have often made the process of getting an appointment more difficult.

While I understand the frustration, violence and abuse towards GPs and their teams will never be tolerated.

GPs and their teams need to feel safe at work, and the NHS is making £5 million available for practices to improve their security measures as part of our plan.

Another way we’re going to ensure more time is spent with patients is by spreading the workload.

I want every practice to use the NHS Community Pharmacy Consultation service, so our brilliant community pharmacists can do more in terms of prescribing.

I’m asking my department to work with the NHS and look at a ‘Pharmacy First’ scheme for England, so pharmacists can provide treatment for specific conditions such as sore throats, without patients having to go to their GP – building on pilot schemes in England and much as they already do in Scotland.

We also need to measure GPs against clearer standards. The vast majority of GPs are doing brilliant work, but where GPs are not, we have to fix it: it’s simply not fair for their patients to suffer in silence.

The challenges in general practice are far from over, but I have every confidence we can meet the difficulties ahead by working together to achieve our common goal – delivering for patients. 

Family doctors are the front door to the NHS… we’ll help them see more patients face to face, pledges chief executive AMANDA PRITCHARD

By Amanda Pritchard for the Daily Mail

The public understands that family doctors are the front door to the health service, which is why the NHS has set out a clear plan today to make access to GPs easier.

We will encourage and support GPs to provide more patient consultations, including increasing the proportion of appointments carried out face to face, reflecting patients’ preferences.

The Daily Mail continues to be a strong voice for patients, and throughout the pandemic the newspaper has given fantastic backing to NHS staff as they have worked relentlessly to help the country.

GPs and their teams are vital to patients and to the wider NHS: primary care has delivered the lion’s share of the country’s most successful vaccination programme ever, while also conducting more than 300 million appointments.

Patients value their GP, so it’s understandable that they want quick, convenient and reassuring care and support from them.

And I know the overwhelming majority of GPs and teams provide exactly this, with our package of measures today targeting additional resources to increase access where practices are not offering the appropriate level of in-person appointments.

But we need to go further, and for too many patients it is more difficult than before Covid to get an appointment as quickly as they may have in the past, not least because of the major challenges caused by the pandemic. 

The right consultation with a GP can spot serious issues early, which is better for people’s health, prevents problems escalating and can reduce additional demand on other staff, allowing them to focus on delivering care for other patients. 

The measures we’re setting out today will reinforce primary care as we head into what will be a tough winter, and will give practices resources to boost capacity to see patients over the coming months.

We’re also investing in better technology for surgeries, to tackle the frustration that is felt by both patients and surgery staff, when people face long waits over the phone to a practice.

The plan we’re publishing today will help ensure Mail readers and people across the country get the care and support they need from their GP, which I know is rightly so valued by our patients and so essential to our NHS.

Pharmacists to get more power: Chemists will prescribe extra drugs and treat wider range of illnesses under plan to free up GPs for face-to-face appointments

Pharmacists will become the first port of call for most minor illnesses under plans being considered by Sajid Javid to free up GPs to deal with more serious cases.

The Health Secretary’s battle plan for improving access to family doctors includes options to give local chemists enhanced powers to treat a wide range of minor complaints.

This is likely to include handing them the power to prescribe a number of medicines which are currently the sole preserve of doctors.

A health source said Mr Javid wanted to see a ‘substantially’ increased role for pharmacists, adding: ‘He is looking at expanding quickly the role that they play.

‘He is interested in whether they can do more in terms of prescribing.

‘It is all about sharing the workload and freeing up GPs to deal with more complex cases.’

The source said the Health Secretary was examining the ‘Pharmacy First’ scheme in Scotland that allows pharmacies to treat a wide range of common conditions from earache and sore throats to hay fever and cystitis.

Ministers hope the scheme will make it easier for patients with minor conditions to get treatment more quickly, as well as freeing up GPs.

Writing in the Mail today, Mr Javid said: ‘Another way we’re going to ensure more time is spent with patients is by spreading the workload.

‘I want every practice to use the NHS Community Pharmacy Consultation service, so our brilliant community pharmacists can do more in terms of prescribing.

‘I’m asking my department to work with the NHS and look at a ‘Pharmacy First’ scheme for England, so pharmacists can provide treatment for specific conditions like sore throats, without patients having to go to their GP, building on pilot schemes in England and much as they already do in Scotland.’

The move is likely to be welcomed by pharmacists, who have been pushing to play a bigger role in community healthcare.

Around 800 GP practices are currently signed up to the Community Pharmacist Consultation Service, which refers patients with a limited range of minor conditions to their local pharmacy.

The scheme, launched in 2019, has so far led to 64,000 referrals, freeing up valuable time for GPs.

But Scotland’s ‘Pharmacy First’ scheme goes much further.

Patients living north of the border are advised to attend a local pharmacy for advice and treatment on all minor illnesses and health concerns, ranging from backache and verrucas to eczema and allergies.

Patients can attend any pharmacy for advice, and in most cases they do not need to make an appointment.

Those requiring privacy can seek advice in dedicated consultation rooms.

Pharmacists have the power to issue advice and prescribe medicines, including antibiotics, if needed.

However, patients displaying unusual or serious symptoms will be referred to their GP or local hospital.

As with GPs, pharmacists will keep records of all treatments.

A health source said Mr Javid would consider whether to replicate the Scottish scheme in England wholesale or adapt it.