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Prevent the death of general practice as we know it in North West London – and soon elsewhere too.
Your GP will NOT be Seeing You Now
The end of the Family Doctor is on the cards in North West London. And if this succeeds here, it may soon be coming to a surgery near you, anywhere in England.
In plans that were originally to be rushed in for the start of April 2024, but which are now delayed for a year because of rapid patient and GP opposition, most people with all GP Surgeries in the London boroughs of Harrow, Westminster, Kensington & Chelsea, Hammersmith & Fulham, Hounslow, Brent, Hillingdon, and Ealing face having their requests for GP appointments diverted away from their Surgeries to area hubs staffed mainly by non-doctors.
What is changing?
The North West London Integrated Care Board (ICB), which funds the GP surgeries primary care system, plans that patients telephoning for urgent appointments will be transferred to an area “Same Day Hub”.
There, a care coordinator (who is not medically trained) will then decide how to deal with that appointment request. These hubs will be staffed by a selection of “additional role” health practitioners (see https://www.england.nhs.uk/long-read/additional-roles-a-quick-reference-summary/) – not doctors – and one roving, supervising GP.
Only if you have a “complex long-term condition” will you be expected to see your doctor in the GP Surgery where you are registered. How you qualify for this description is anybody’s guess.
Not one of the 2.4 million residents of North West London have been asked whether this is a change that they want – neither individually nor through representative patient groups.
On 5th March – less than a month after these plans first started to become public, and a month before they were to be forced onto all GP Surgeries in North West London – the ICB was forced to delay for a year.
North West London ICB has performed no formal risk assessment on the clinical safety for patients in this rushed-through scheme. Nor did it perform any analysis of the effects of its proposed changes on any protected vulnerable groups. Neither does NWL possess any evaluation from a handful of partial and unfinished local pilots.
Only mass patient action will build on the climbdown of 5th March and prevent the end of the Family Doctor in North West London.
What has been done to stop this?
On the 9th February, the Londonwide Medical Committee – the London doctors’ senior professional body – sent NWL ICB a 9-page letter of concern, raising 15 detailed questions on safety, practical, clinical, equalities and ethical grounds.
Ten days later, the ICB sent the LMC an inadequate and vague reply and also wrote to lead GPs “apologising” for causing “confusion, anxiety, concern and anger”, asking for a “reset of the conversation”.
The ICB is already running scared, even though patients have as yet hardly begun to speak. This change.org ‘Keep Doctors not Call Centres’ petition can begin to make the voices of the people of North West London heard at the ICB.
Despite attempts to change their tone, the ICB insisted they stand by nine “Key Principles” of the new contractual scheme. They also claim that it was now too late to separate out this controversial new scheme from the April 1st new contract for GPs – before changing their minds two weeks later.
On multiple grounds of safety, legality and duty-of-care, the London Medical Council advised Surgeries in North West London to think very carefully before they decided to cooperate with the ICB plans.
Five things at least are in principle wrong with the NWL ICB proposal, which remains the ICB plan:
- It takes away equal access for all patients to be cared for by their GPs, a founding principle of the NHS, and impacts equalities.
- It risks patients’ health because care coordinators are not clinicians, without medical training to assess a patient’s needs, even if they have access to that patient’s medical histories.
- It divides patients into two nonsensical categories – “same day urgent” or “complex” – and puts the responsibility for deciding this on non-clinical staff and patients themselves.
- No extra staff or premises are supplied or funded for these remote hubs, but will be subtracted from GP Surgeries.
- It leaves many GPs with grave safety concerns for their patients.
“It’s a spectacularly bad idea … it throws continuity of care and the importance of the doctor-patient long term relationship to the wolves. A good doctor-patient relationship is built up over multiple encounters, some of which may initially seem trivial but all of which add up to a solid base, which can be built on when the going gets tough.” (Dr Helen Salisbury)
A massive change … with no consultation
In this document, NWL ICB promised ‘to avoid “top down” policy making and service development’, that residents ‘will be involved in key decisions that affect you’, ‘to co-design our future strategies with people and communities’, and to provide ‘timely … transparent’ communication to the people they serve.
Unless the people of North West London make their voices heard loudly during 2024:
- the majority people will suddenly find themselves barred from continuity of care with doctors whom they know and who know them;
- patients’ health will be put at risk by being assessed by non-doctors operating with only limited medical supervision;
- our family doctor’s surgeries will be stripped of staff and resources to become, in effect, refer-in services solely for patients deemed complexly sick.
