The Additional Roles Reimbursement Scheme (ARRS) has been a ‘Trojan Horse’ in general practice resulting in GPs being ‘replaced’, according to a BMA GP leader.
Speaking yesterday at Pulse LIVE, sessional GPs’ committee deputy chair Dr Venothan Suri told attendees that ARRS funding has ‘created the perfect storm for GP unemployment’.
RCGP vice chair for external affairs Dr Victoria Tzortziou-Brown and the National Association of Sessional GPs’ (NASGP) chair Dr Richard Fieldhouse also spoke at the event, which explored whether general practice has moved from a recruitment crisis to a retention crisis.
Dr Fieldhouse argued that, instead, general practice is experiencing an ‘existential crisis’ where GPs are undervalued.
He said: ‘I think it’s much more about being valued. I think it’s about the Government valuing us and allowing practice managers to choose to use that ARRS funding in a way that best speaks to them. Not just to corral that into simply employing ARRS roles.’
Sharing data from LocumDeck, NASGP’s booking platform for locums, Dr Fieldhouse said there is a ‘huge amount of untapped capacity in general practice’.
‘The new data we’ve started to look at is the unfulfilled sessions – what that means is locums were able to work and they put their sessions onto LocumDeck to get booked, but they weren’t. And in the last year that volume has doubled,’ he revealed.
Dr Fieldhouse also urged the profession to ‘get away’ from a place where GPs have ‘nailed continuity to our flagpole’.
‘There’s so much more we can do. There’s so many lovely things about being a GP that you can do for your patients that’s not just about continuity. There’s access, there’s a second pair of eyes, there’s fresh opinions, there’s continuity of record.’
Dr Tzortziou-Brown welcomed the Government’s commitment to increasing GP training places, but pointed to recent findings that these projections are based on ‘significant substitution’ of fully-qualified GPs with trainees and SAS doctors.
GP training also seems to have ‘become quite popular’ in recent years, with the rate of applications increasing since 2015, according to Dr Tzortziou-Brown.
She added: ‘However, we can’t be complacent, because if general practice is not valued, if it doesn’t continue to be valued in the future, there is a risk of actually people may not choose to train as GPs.’
The sessional GPs committee deputy chair Dr Suri showed recent BMA survey findings which revealed locums have experienced a reduction in sessions over the past year.
But he revealed that practices were reporting an increase in locum spend of almost 14%, and the BMA was trying to ‘square’ this ‘difficult’ circle.
Dr Suri said: ‘The focus has really gone now to much more of a retention crisis. Is the NHS’s long term plan really just to have one GP partner supervising a whole host of ARRS roles with no real need for sessional GPs in the practice? Is that really what we want for our profession?’
Pointing to plans for same-day hubs in areas such as North West London, he argued that this is ‘already happening’ locally and is ‘very worrying’.
Dr Suri also warned against ‘begrudging’ locum colleagues for choosing a more ‘flexible’ working pattern, and instead asked attendees to direct criticism at the Government.
‘It’s not begrudging against our own GP colleagues, it’s grudging against the poor Government contract that we’ve been given, and actually been shafted.’
On ARRS funding, he said: ‘I really feel that this has been the Trojan Horse in general practice. The £1.4bn allocated for practices to have allied healthcare professionals, really to improve access targets but not quality care, has really meant that GPs are being replaced and not being able to find work.’
In the most recent contract negotiations, the BMA argued for GPs to be included in the ARRS.
However, NHS England rejected this ask, saying GPs are ‘not additional’.
Over recent months, there have been increasing reports around GP locums struggling to find work, with some putting this down to an increase in ARRS roles.
In January, a practice in Surrey said it was making three GPs redundant due to ‘new ways of working’, including the use of ARRS staff, and virtual rather than physical consultations.
Pulse LIVE London continues for a second day today, with a keynote speech from GPC chair Dr Katie Bramall-Stainer.
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One of the top 2 concerns of the public re the failing NHS is not being able to see a GP. They are not fooled. The government missed the pont when patients said tehy couldn’t see their GP and equated access to an appointment with a non GP at their GP surgery with access to ther GP. Access has improved but patients know their care hasn’t mproved and still want to see their GP. I’ve had patients in tears, no lie, when they see me that they are so releived to see an actual GP and discuss all the things they wanted to discuss that had been fobbed off onto other roles and they just hadn’t got the satisfaction in care they wated. antidepressants started and followed up by pharamcists, multiple minor complaints they just wanted to talk through. The patients and the public are not fooled. And every time the DHSC says we are offering X more GP appointments we need to say. No. You’re not. You are offereding X more appts at a GP surgery not with a GP. That is the whole point.
I agree, the DHSC employs numbers for its version of lies, damned lies and statistics.
Re Dr Fieldhouse’comments, I agree that there are “lovely things about being a GP” but he then goes on to list access (a political funding issue), “second pair of eyes”, “fresh opinion” and continuity of record, all of which add up to undermine the GP’s historic role of first/undifferentiated contact (exactly what ARRS is set up to do). For me continuity of care is the source from which has flowed the genius of traditional general practice, a power that HMG is out to destroy.
Dr Fieldhouse missed an opportunity by not saying ‘a second pair of eyes between GPs’. But the RCGP are playing politics with the profession, and devaluing it by their stance.
General Practice has been devalued over a number of years.