“Blockbuster famously went bust, for Mr Javid to fail to even acknowledge the workforce and staff retention issues shows how out of touch he is with the crisis the NHS and social care system faces through his lack of investment over the last decade. Does he actually care or is he more concerned about soundbites than patient care?”

The Doctors’ Association UK criticised the plan for “soundbite generation” rather than “coherently and realistically” addressing workforce planning.

You can read the full article here.

Sir, More reorganisation will not solve the crisis with NHS waiting lists or prevent chronic disease, inevitably worsening care as resources are diverted to plan the shuffle (“GPs nationalised in Javid plan to reduced hospital admissions”, Jan 29). It is well evidenced that what reduces hospital admissions is continuity of care, ie seeing the same GPs over a number of years. The issue is workforce retention. We have fewer GPs than ever before yet are offering more appointments. The job is highly stressful, often miserable.

Public health faced a similar reorganisation and has seen its budget decimated, and we wonder why we have rising numbers of chronic conditions. We suggest the health secretary visits some GP practices to understand the issues.

It is also important to note that there is no charge for sick notes, which are now called “fit notes”. The private work extends only to non-NHS work such as insurance reports, medicals and private letters. The income from this is minimal.
Dr Lizzie Toberty
GP lead, Doctors’ Association UK

Gp Online and Medscape wrote about our letter to Sajid Javid – you can read the letter here:

Dear The Rt Hon Sajid Javid,

We write to you as a very concerned group of GPs regarding the lack of access to secondary care referral pathways.

You will of course be aware that access to secondary care outpatient services now has extremely long waits across a range of specialities. 

This is putting huge undue pressure on primary care. For example, those waiting for joint replacements do not contact their surgeon for fit notes, pain relief, antidepressants whilst they are waiting. This is one small example of the very real-world consequences for GPs when our patients cannot gain the specialist in put they need. We are additionally seeing patients waiting months for physiotherapy and years for certain mental health assessments for autism and ADHD. These are just a few examples. 

As GPs we are seeing an increasing amount of referrals rejected at the outset. This is a huge concern for us regarding patient safety. It also often leaves nowhere to go with that patient and their care. 

Therefore, those who have the resources are turning to private referrals, those who can’t are left to suffer.

We are also concerned regarding the growth of mandated advice and guidance (A&G) as is being trialled in London currently. A&G is a brilliant tool if there is a query over patient care, or some concern over whether a referral is appropriate. 

However, as GPs, if we have decided a referral is necessary, and the situation is outside our competency then we must refer onwards, in line with GMC advice. 

Allowing specialists who have not assessed the patient themselves to make the decision whether a referral is justified, is not in keeping with the current emphasis on face-to-face consultations, and risks patient safety. 

We are witnessing a huge increase in demand in demand for private referrals. A recent poll of our members showed 100% of the doctors who replied believed private referrals were on the rise. 

Whilst private referrals have their place for some patients, patients should not need to resort to them for necessary care.

Most concerning of all, 90% of respondents believed a patient of theirs had come to harm because of a lack of access to outpatient services. 

Our worry is this lack of access to secondary care, followed by increased rationing of specialist opinions is now leading to two-tier healthcare – where the NHS is available for acute emergencies and cancer care, but to have good, appropriate management of many common conditions, patients must either fund their own care privately or suffer. This is not only against the founding principles of the NHS, it stands to widen health inequalities. 

There must be urgent action to remedy this. 

We ask:

• recognise the impact of these waits on primary care, the need for greater resources and a review into primary care access
• recognise that if GPs need to refer patients, rejection of referrals must be the exception. A clear explanation and alternative plan must be given. All rejection letters should be personalised and written directly to the patient, with the GP copied in
• halt all moves to mandate A&G
• continue discussions to reduce waiting times
• finally, please visit our practices. Please come and understand first-hand the pressures we are under and listen to the solutions. Some things need decades to remedy, but there are quick wins too.

We look forward to hearing from you.

DAUK GP committee

Doctors for the NHS

GP Survival

999 Call for the NHS