Barriers

“We know being in work is important for people’s health, and people want to work. What is not mentioned are the barriers to this.” Dr Shire said that while job coaches can help with training and interview skills, many people with disabilities and long-term conditions need sustained, practical support to stay in employment. “People with long-term health conditions, disabilities, or impairments have a lot to offer employers, but many will need support in the workplace and employers may need support to keep that person in their job,” she said. “For example, someone with a hearing impairment might require a British Sign Language interpreter. Who will fund that?”

Access to Work

She added delays and rejections in the Government’s Access to Work scheme had already left many without the help they need. “Upskilling is helpful, but it’s not the only barrier preventing people from working. Who is going to provide the support long-term?” Dr Sarah Jacques, DAUK GP co-lead, raised logistical concerns about the proposal. “The DWP has been trying to do this for a while,” she said.

GP practices

“However, when I have spoken to my regional DWP, it hasn’t been able to have a presence in GP practices as there aren’t any spare rooms. “It also only has enough coaches to be in a surgery once a month. “On one occasion they wanted a delay in issuing a sick note until the patient had seen a job coach. “The coach was only going to be able to offer a handful of appointments each time they were present. “How am I going to reason with a patient that they may have to wait four weeks before they saw someone when they might not have any money to survive that four weeks? “Unless DWP is going to up capacity and GP surgeries turn into a Tardis, I don’t know how this is going to work.” DAUK committee members are all volunteers and campaign about issues facing doctors in their own time. Please support our work by joining DAUK or donating to our GoFundMe.

GP co-leads Dr Sarah Jacques and Dr Steve Taylor attended the meeting on behalf of DAUK.

Ahead of the talks, DAUK surveyed GPs across the UK on the future of fit notes to ensure their views were represented.

Fit notes

We asked for their views on whether fit notes should be the remit of GPs, whether a new service should be responsible for them, and whether there should be a return to the Covid plan of four-weeks self certification, GP input after four weeks.

GPs were also asked if they would prefer patients to fully self certify for any illness, and whether refusing a fit not can impact the doctor/patient relationship.

The survey received 213 responses, which were all anonymised before being shared with the DWP. It found:

• 69% of GPs said fit notes should not remain part of their remit
• 85% felt a new service should take responsibility for issuing fit notes
• 46% supported a return to four weeks self-certification
• 51% did not favour self-certification by patients
• 94% reported that refusing a fit note negatively affects the doctor/patient relationship

Dr Jacques and Dr Taylor said: “We are pleased that the voices of our members and of frontline general practice were heard in this important discussion.

Listening to GPs

“We welcome the DWP’s willingness to listen to GPs as they look at how fit notes could evolve.”

The discussions come as the Government undertakes a new pilot scheme to reform the way fit notes are issued. The WorkWell Primary Care Innovation Fund is backed by £1.5 million across 15 regions.

The Government says the pilot scheme will look to find other ways to help people back into work.

Pilot scheme

DAUK’s GP committee member Dr Rosie Shire spoke on national radio about the scheme when it was launched last month.

Speaking on LBC, Dr Shire challenged assertions GPs ‘immediately write people off with a fit note’.

She said: “We want people to work and people do want to work, and that’s really important.”

DAUK’s GP committee will continue to engage with members and represent their views on this and other issues around general practice.

Please support our work by joining DAUK or donating to our GoFundMe.

Support earlier

“There are times when someone has, say, back pain or mild depression or anxiety. Getting them support earlier would be really good. “But to say GPs stop giving out sicknotes and instead we refer everybody who gets one to get them back into work – there are a lot of people who are more seriously unwell and it’s not as simple as that. “Most people who are unable to work long-term would actually love to work.” Speaking on LBC, Dr Shire was asked about the numbers of fit notes issued having doubled since 2015. “We know that Covid has caused a lot of long-term problems,” she said. “Maybe it’s that people have struggled to get interventions. “If you have a mental health issue or are struggling with workplace stress, getting early access to therapy to support you means, perhaps, you can go back to work sooner.

Waiting times

“But if you’re having to wait six months for that intervention or you need a knee replacement because you can’t do your job, having to wait a year or longer for that surgery means you can’t work. “It’s not as simple as just stop giving a sicknote. “We want people to work and people do want to work, and that’s really important.” The WorkWell Primary Care Innovation Fund will is backed by £1.5 million across 15 regions. The Government says the scheme will look to find other ways to help people back into work. It is expected to support up to 56,000 disabled people and people with health conditions into work by spring 2026. Please support our work by joining DAUK or donating to our GoFundMe

National Insurance contributions

“Sadly, much of the increase in funding will be lost to National Insurance contributions, staff and on costs. “While there has been an acknowledgment of the need to invest in community services, a much larger investment will be needed to reverse the decline and build more capacity for the future. “We look forward to seeing greater emphasis placed on GP provision in the future years. “We also hope that amendments to the legislation on National Insurance contributions for GP practices, recommended by the House of Lords, will be implemented without a cut in this proposed budget.” His comments come as GPC England voted to accept the proposed contract, which includes an overall funding uplift of £969m for 2025/26, contingent on full renegotiation of the national contract within this parliament.

Contract changes

Key headlines from the 25-26 GP contract changes:

• £969 million new investment uplift – comprises £889m additional core contract funding and £80m for use of e-RS advice and guidance between GPs and consultants.
• This investment is on top of the £433m added to the contract during autumn last year.
• Enhancement of ARRS, with GPs and practice nurses added in to the main scheme, minimum GP salary + on-cost reimbursement increased in line with the BMA salaried GP pay range and with no caps on numbers
• Enhanced service for ‘pre-referral’ advice and guidance with a £20 item of service fee payment per request by GPs
• Restoration / uplift of SFE payments (sickness/parental leave cover) in line with 2025-26 real-terms values (compared to 2018/19), including locum reimbursements and childhood vaccination payments.
• Changes to requirements for patient online e-consultation access to general practice from October 2025

Continuity of care

Dr Lizzie Toberty, DAUK GP lead, said: “We welcome the Government’s emphasis on continuity of care and patients being able to see the same doctor. “This is how high quality care which facilitates the move from hospital to community can happen, and there are huge efficiencies to be gained as well.” Dr Rosie Shire, DAUK GP committee member, added: “The move to increase ARRS (Additional Roles Reimbursement Scheme) funding for GPs is helpful.

ARRS posts

“However, it is not clear if GP ARRS posts are going to be open to experienced GPs as well, or whether they will continue to be restricted to those within two years of qualifying. “We have thousands of GPs out of work and struggling to find work, and practices need to be able to employ the GPs they need. “Funding GPs, who can give patients continuity of care, is the best use of the ARRS funds and will keep more patients out of hospital.” Please support our work by contributing to our crowd funder or by becoming a member.

General practice

Dr Ellen Welch, DAUK vice chair, said Mr Streeting’s speech to the NHS Providers conference made no mention of GPs. This was ‘despite Lord Darzi’s report advising him to invest in general practice’. She said: “In England, the number of medical staff working in hospitals has increased by thousands while general practices have closed in their hundreds, and the primary care workforce is shrinking with almost 2,000 fewer GPs than we had in 2015. “Despite this, an average of 1.4 million GP appointments per working day were delivered between March 2023 and February 2024. “Mr Streeting is looking for better value for money. General practice is already providing remarkable value for money and with proper funding can provide even more.” Dr Lizzie Toberty, DAUK’s GP lead, warned the proposals may demoralise staff. She said: “I broadly support more accountability for managers. “Helping struggling trusts rather than demonising them is vital to reducing the toxic culture which exists in so many.

NHS league tables

“However, when did league tables in health or education ever improve care? They solve nothing. In the worst cases they will demoralise staff and encourage manipulation of the figures. “The announcement is massively avoiding the elephant in the room, namely National Insurance contributions which are about to collapse general practice.” Dr Welch echoed Dr Toberty’s concern league tables would hit morale. She said: “Introducing league tables sounds like a sure fire way to demoralise hard working staff even further. “No one goes to work in the NHS to do a bad job. I worry these plans are going to create more problems for trusts that are already struggling.”

Postcode lottery

Dr Sarah Jacques, DAUK GP committee member, said many factors might contribute to underperformance. She said: “A rewards system feels like a postcode lottery with the ones doing well getting more funding and the ones doing badly getting funding cut – and then getting worse. “Tertiary centres may end up with worse outcomes due to more complex cases with higher risk. “There are too many factors that can’t be directly compared. Different demographics, poverty levels, functioning versus non-functioning local authorities. “League tables oversimplify it all.” Dr Rosie Shire, DAUK GP committee member, added: “We already have Care Quality Commission (CQC) ranking hospitals in a similar way to Ofsted. I don’t think that has helped improve things. “How will league tables show anything different to CQC ranking? And how will it all impact upon the mental health of staff?”

GP investment

Dr Steve Taylor, DAUK GP committee member, said he was ‘somewhat surprised’ Mr Streeting failed to mention GPs in his speech today. He said: “By the end of today 1.4million people will have consulted in general practice and half the population by the end of the month. “A continued focus on secondary care fails to address the problem, that with just 5.6 per cent of the NHS budget going to GP practices, they cannot provide the services needed to prevent illness, support patients in their homes and provide care closer to home. “Proper general practice investment will fix the NHS and improve care for patients.” Support the work of DAUK by becoming a member or donating to our Go Fund Me. Read Mr Streeting’s speech in full.

DAUK’s GP Committee stands ready to work with Wes Streeting on cutting bureaucracy and addressing issues with primary and secondary care communication.

It follows a speech by the Health Secretary at the Royal College of GPs conference in which the Government launched a so-called Red Tape Challenge with NHSE to cut down on bureaucracy and free up GPs’ time to spend with patients.

DAUK’s GP Committee welcomed his focus on primary care but said the solutions needed input from GPs.

The committee also called on Mr Streeting to tone down the ‘negative rhetoric’ around general practice which was ‘encouraging resentment towards GPs’.

Urgent attention

Dr Lizzie Toberty, DAUK GP lead, said: “The interface between primary and secondary care is problematic and needs urgent attention.

“While Mr Streeting has understood the diagnosis, the treatment is wide of the mark and would benefit from input from GPs on the ground rather than managers in Whitehall.

“Negative rhetoric from Mr Streeting is not helpful and encourages public resentment towards GPs, who are desperately trying to do their best for their patients in a failing system.

“It also compounds the low staff morale highlighted in Lord Darzi’s recent report.”

Dr Ellen Welch, DAUK vice-chair, said proper funding for general practice to meet demand, which is at an all-time high, to retain and recruit GPs, and stop the closing down of practices should be the priority for the Government when it comes to primary care.

She said: “In England, the number of medical staff working in hospitals has increased by thousands – 163 per cent more consultants over the past 25 years – while general practices have closed in their hundreds, and the primary care workforce is shrinking with almost 2,000 fewer GPs than we had in 2015.

Demand

“Despite this, demand is high, and an average of 1.4 million GP appointments per working day were delivered between March 2023 and February 2024.

“On top of this, GPs are being expected by hospital teams to perform additional work for free. Every day, general practices across the UK receive letters asking GPs to kindly complete an array of unfunded tasks.

“Referral forms are a small part of our daily red tape but much more time is spent dealing with unfunded requests from secondary care such as ordering and chasing blood tests and investigations; providing fit notes or prescriptions for patients who have been seen in hospital; referring patients to another specialist; and chasing relatively small pots of money from ICBs.

“For the past decade, funding for hospitals has grown twice as fast as funding for general practice.

“Getting rid of a few referral forms will not revolutionise primary care, and on the whole GPs have taken the initiative to do this already.”

Collective action

The GP Committee also responded to Mr Streeting’s call for GPs in England to end collective action, with the Health Secretary saying he understood why doctors ‘wanted to give the previous government a kicking’.

GP spokesperson Dr Rosie Shire said: “Collective action is not about giving anyone a ‘kicking’. It is about doing what we are contracted and paid to do.

“No other section of society expects public or private sector workers to do work for free, and NHS general practice can no longer allow the service to run on goodwill when they are at risk of closing under the pressures.”

GP spokesperson Dr Sarah Jacques said investment was also needed in IT and estates to improve efficiency. Indeed, the Darzi review of the NHS found that ‘crumbling buildings hit productivity’ as well as impacted staff morale.

Dr Jacques said: “Primary care needs a fully-funded model with the promise of a long-term uplift to core funding.

“Buildings which are not fit for purpose and IT belonging somewhere in the last decade also need urgent attention.

“Only then will we see some meaningful change.”

Become a member of DAUK and support our work.

The Prime Minister was speaking at general election rally in Wiltshire when a GP questioned him about changes to funding available to recruit staff.

The GP, understood to be Dr Jane Lees-Millais, said the NHS was ‘disintegrating’ and said that she was one of 2,500 GPs in the country currently unemployed because of the Government’s policies.

“The country is not stupid,” she said. “They know when lesser qualified people are being used to conduct consultations which are massively complex.”

Mr Sunak responded by saying his dad was a GP and mum a pharmacist, and that he understood primary care.

He said he was ‘making it easier for people to see other primary care practitioners to get the treatments they need’.

General practice funding

Dr Shire, of the Doctors’ Association UK GP committee,  told national radio listeners that GPs were not allowed to spend funds from the Government on hiring GPs or practice nurses.

Speaking to Vanessa Feltz on LBC, Dr Shire said: “There’s concern within general practice that the demand is increasing and yet we have 2,000 fewer GPs than we did in 2015.

“Although they are putting money into primary care, unfortunately, that money is ring-fenced so it can’t be used for GPs and practice nurses.

“It can only be used for other patient care roles, such as pharmacists or physios, which is great and they definitely play a part in primary care, but we have GPs coming through the system, they’re trained up, they want to work, and they can’t get jobs.

“We have patients who want to see GPs but they haven’t got that choice anymore.”

She said that allied healthcare professionals had an important part to play in Primary Care, but that GPs ‘trained for much longer and have that depth and breadth to see the person as a whole’.

“As people get older they’re going to have more health conditions and that then does cause more complexity,” Dr Shire said.

“Healthcare professionals who aren’t medically trained perhaps won’t be able to look at that as a whole and understand the depth of what might be going on.

“It’s having that picture as a whole and making sure people are seen by the right person, and a GP is able to look at that in one go.

“If people see a physician, that costs less than seeing a non-physician such as a patient care role that isn’t a GP or a nurse.”

Is the NHS broken?

Asked by Vanessa Feltz whether the NHS was ‘disintegrating’, Dr Shire said: “We’re worried it might be broken. It’s definitely not doing well at the moment.

“People are becoming more unwell. We have more people needing care.

 “If we can get people the healthcare they need earlier, we can get them back on their feet and working again.”

Dr Shire added: “I think a lot of GPs and a lot of doctors are starting to feel demoralised and dispirited.

“You train to become a doctor because you want to help people, you know what that person needs and you can’t give them that.

“That is really hard and I think we’re seeing more and more GPs burning out and struggling themselves.

“The services that support GPs and doctors with their mental health are struggling because we’re struggling ourselves.

“But we keep going back because you want to do what you can and you want to do your best.

“If you can’t do that, it doesn’t feel very nice.”

Become a DAUK member and support our work.

DAUK is holding a briefing for prospective MPs on Wednesday 19 June to discuss the crisis in general practice and things that could be done to tackle it.

The briefing, Why Can’t I See My GP? The Great British Paradox, is based on the book Why Can’t I See My GP?, a copy of which DAUK sent to all 650 MPs in March.

The briefing will be held members of DAUK’s GP committee, including its chair Dr Lizzie Toberty, past DAUK co-chair Dr Ellen Welch, and members Dr Steve Taylor and Dr Sarah Jacques.

DAUK is asking people to invite the candidates standing in their constituency to attend the briefing. Find out the candidates in your constituency at https://whocanivotefor.co.uk/

Find out more about the briefing.

Contrary to widespread reports, GP surgeries have remained open throughout the Covid-19 pandemic. Official NHS data confirms that more GP appointments are being offered than ever before, and GP teams continue to provide over 90 percent of all NHS consultations. 

Practices were already struggling prior to the pandemic and are now facing near-impossible challenges in the face of a “tsunami of demand”.

Attendees at this briefing heard from frontline GPs who described:

• The causes of rising demand on our services
• The increasing cases of burnout amongst GPs
• The damaging effects of unproven bureaucratic interventions
• Consequences of the demoralising, harmful narratives against our profession
• Proposed solutions to our challenges
• How you can help us help our patients

The frenzied news that a new ‘worst ever’ strain of Covid has been found should come as no surprise to anyone.

Public Health England (PHE) and health authorities around the world are continuously monitoring and checking samples of Covid to look for changes to the type of infections we’re getting. So this is not the only variant on the watch list. There are 14 others of concern that PHE is investigating.

On the whole, we should be pleased that this strain – known as Omicron – has been picked up. This means that the monitoring is working and enables scientists to examine changes in the virus in far more detail.

So why is this variant in the spotlight? Scientists noticed that the Omicron protein spikes on its particles are different to those on other Covid strains. And the vaccination identifies the virus using these particles. So what we don’t know yet is whether the jab will be able to identify this new variant because of the mutations in the protein spikes.

In the UK, Covid cases are limited by the vaccination rollout. The jab reduces the chances of catching and spreading the virus, along with helping the body to fight it off. People who get the virus are less unwell, and not as likely to need hospital admission or require intensive care.

If this new variant is immune to the vaccination, then we risk ending up in a situation like last winter where cases soar exponentially and hospitals and intensive care units will struggle to care for the number of Covid patients.

We’re currently offering flu jabs to people who are more likely to be seriously unwell if they catch it, in preparation for ‘flu season’ – which is January to March. Viruses such as flu, Covid and colds are more likely to spread in the winter months because people meet inside more and are closer together.

Currently, we’ve yet to see a case of this new variant in the UK, but we need to be aware of it and remember that this pandemic is far from over.

Thankfully, we have the advantage of a mostly vaccinated population that protects us from most strains of Covid. Added to that, manufacturers are already seeing if they can make alterations to the vaccination, if necessary, to ensure it protects us from this new strain.

So, what can we do in the meantime to protect ourselves?

We can help reduce the spread and the chances of catching it by following the simple steps we all got so used to last winter. Frequent hand washing and avoid touching your face and mask when out and about. We know wearing a mask or face covering reduces the chances of passing on and catching Covid, so doing this protects you and others. But it really is essential to make sure it completely covers your nose and mouth and fits well on your face, with no gaps around the side or top.

The last 20 months have been all about social distancing. If we start to think about this again, we can help slow down the spread – along with other viral infections such as flu and cold. And we should all make sure that indoor spaces are well ventilated to increase airflow to reduce the amount of Covid in the air.

It’s hard to make people follow these measures, however, when we see politicians crowded together in parliament, not wearing masks.

Lastly, there are lots of viruses that cause temperatures and coughs, but the only way to be sure it’s not Covid, is to book a test. There needs to be far more publicity around the use of the lateral flow tests (LFT), which are not as sensitive at detecting Covid as polymerase chain reaction (PCR) tests. But the LFT is much easier – you can take it at home and get result in 20 minutes. It’s understandable that people are reluctant to go online, book a PCR test, drive to the site, then isolate at home while they wait for the results. But LFT miss a third of Covid cases, so it is really important to book a PCR test if you have symptoms that could be caused by Covid. The PCR test is much more accurate at detecting Covid, even if it does take longer to get the result.

Using all the above measures are proven to reduce Covid levels. And until we know if the vaccination will protect us again this new ‘worst ever’ strain, we ALL need to do them again. 

Dr Rosie Shire is a GP and member of the Doctors’ Association UK GP Committee.

Read the original piece here

The guilt of of burdening my colleagues and abandoning patients was overwhelming. But I was going to break if I didn’t stop and take time to heal away from the pressures of the current climate

“I first realised I was burnt out when I was reduced to tears at work, after being asked to “squeeze in” an extra patient in my already overflowing clinic. I ploughed on, but the tears told me that I had reached breaking point.

Burnout is the physical, mental and emotional exhaustion caused by extreme and prolonged periods of stress in the workplace. Even before the pandemic, GPs and emergency department doctors had higher burnout scores than any other group of doctors. Now things are even worse, with burnout rates 20 per cent higher and an average of three GPs leaving the profession every day.

The demand is unrelenting. GPs are routinely working 12-15 hour days, reporting 40 or more patient contacts – way above what is considered safe. In March last year as the pandemic hit our shores, NHS England mandated the move to “total triage” in primary care to limit the spread of Covid-19, protecting both patients and staff. Almost overnight, we moved to remote telephone, video and online consults, establishing hot hubs to enable ongoing face-to-face contact if the clinical need arose.

We delivered, at short notice, 75 per cent of a mass new vaccination programme. We dealt with the backlogs resulting from cancelled secondary care work. Data from NHS Digital confirms, contrary to the reports of being closed, general practice was and is busier than ever before. Despite this, we are being shouted at by patients frustrated with delays, and being vilified by large sections of the press. This all takes its toll and GP suicide rates are now four times the national average.

I didn’t go into medicine to defend myself against untruths that general practice has been closed for 18 months (we really haven’t). I’m trying my best and working my hardest to advocate for patients in a chronically underfunded system. If I was able to simply do my job and focus on practising medicine, I could do it. But we are bombarded with so much more than clinical care on a daily basis. Then after a 13-hour day, returning home to see social media comments about GPs refusing to see patients when you’ve just seen, spoken to, or messaged 80 in that one day alone.

Our leaders are unsupportive. NHS England has informed GPs about changes in their contract via the newspapers, and the government claims to provide more funding in general practice, but attach so many strings about when, where, and how it can be spent, when actually most practices just need an extra GP or practice nurse to help take the strain.

We’re constantly hearing that we need to be resilient. Resilience is being able to recover from setbacks without brooding on them; to bounce back from pressure to your starting position. It’s not about working harder with fewer resources, or being able to shrug off abuse. Elastic is very resilient – it stretches a long way, then bounces back to its original form. But even elastic will snap if too much pressure is applied. And this is what is happening to GPs right now. We stretched and now we are getting dangerously close to breaking. And as I found, it’s only going to take one more request, one more adjustment, one more hurdle, before we snap. Every GP who burns out is one less GP to see patients, to advocate, and to care for them. It has already started, and it will continue unless things change.

I didn’t want to have time off. The guilt of burdening my colleagues and abandoning the patients I was caring for was overwhelming – I would be letting them all down. But I was going to break if I didn’t stop and take time to heal away from the unrelenting pressures of the current climate.

Burnout can be eased with medication or time off, but ultimately, for someone to recover, there needs to be changes within the workplace that caused the condition to start with. The entire system needs to change. The workload of individual clinicians needs to be reduced to a safe level without adversely affecting patient care, and to do this we need more funding, alongside more vocal support from government and leaders. If we don’t make changes, there won’t be any GPs left to see patients.”

Dr Rosie Shire has resigned from her NHS GP job