How should general practice be preparing for winter?

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In the early days of the Covid-19 (coronavirus) pandemic, the call to 'protect the NHS' was very much focused on preventing hospitals from becoming overwhelmed. As we enter winter facing a second wave of the pandemic, ensuring the hospital system is resilient enough to endure another crisis will be key. But as we’ve said before, NHS resilience is so much more than hospital beds.

GP activity data at a national level is limited and of poor quality – and it got worse in the first months of the pandemic with over-stretched staff and rapid changes in processes and pathways that disrupted data flows. But as best we can tell, numbers of patient consultations did reduce in the first few months and there was a significant move away from face-to-face consultations to digital appointments in line with national guidance. GPs had also been advised to suspend routine refers to secondary care. Practices and primary care networks rapidly adapted and innovated to offer digital appointments and introduced ‘hot’ and ‘cold’ sites so that patients could still receive face-to-face care when needed. Some routine care which required face-to-face intervention was paused (although essential routine care such as childhood immunisations continued).

Since the summer however, the data we do have suggests that activity levels are increasing to beyond those that would normally be expected in late summer. More than half of consultations take place in person and though a lack of available data means the reasons are hard to quantify, conversations with GPs across the country point to some potential drivers of this activity.

And in the meantime, the workload pressures that existed before the pandemic continue and initiatives that were suspended are now being reinstated. Primary care network (PCN) contract requirements were delayed until October but will now restart, together with new targets for practices to gain access to Investment and Innovation Funding. In-person Care Quality Commission inspections resume in October and PCNs need to move rapidly to spend the additional money for new roles that is attached to the contract, which has been very difficult during the pandemic.

The response to the pandemic saw many examples of just how agile and innovative general practice can be and there is cause for optimism – primary care networks have really proved their worth, allowing GPs to operate across local communities, and forging new relationships with wider community organisations. But with growing demand, an ever-diminishing GP workforce and difficulties in recruiting, inducting and supporting new staff while working remotely (even though funding is available), it’s going to be a tough winter for general practice.

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