GPs are seizing opportunities to make things happen

NHS England’s Deputy Medical Director, Mike Bewick, explains how innovative GPs are already tackling the many challenges that come with the Call To Action.

We are now developing an even greater understanding of the challenges that face Primary Care and how we must work differently to achieve sustainable change.

Thanks to your feedback to my two earlier blogs which has from across the health and social care system.

The ‘Improving General Practice – Call to Action’ has started off your responses on both what needs done and how.

As a GP I understand the call for some space or headroom to think about change; how do we describe what we need to do and how do we then go about trying to deliver it? How do we prioritise the hundred things on the ‘to do’ list and focus on the top three that will really improve the experience of our patients?  The day job sometimes just doesn’t give us time to think about innovation.

That said, going on last week’s special learning event in London, primary care colleagues are doing just that. The nine work-stream leads set out the vision for each of their areas and updated peers and other stakeholders on progress – from patient empowerment to premises and from workforce to information and transparency.

The room was full of enthusiasm, innovative ideas and an appetite to affect real change.

It was clear from listening to colleagues that many have already seized the opportunity to do things differently.  There are a number of emerging new models of general practice provision, such as mergers and federations, and utilising the full opportunities of APMS/PMS contract but we’re really keen to explore new ideas.

In the Improving General Practice – Call to Action, NHS England makes clear it doesn’t want to tell GPs what to do, rather it wants to give them the support and tools that will help secure the future of primary care.

I am absolutely clear that we will not meet the challenges of limited resources, a changing workforce and rising patient expectation unless GPs and commissioners are given the support and legitimacy to change and innovate – even if it doesn’t work out.

A surgery I visited recently is doing just that.  Last week on a visit to St Levan Surgery in Plymouth I was introduced to the system of ‘doctor first’ to address long waits for appointments and dissatisfaction among patients and staff. Sick of queues out of the front door every morning, GPs decided to introduce the telephone-based access system at no additional cost, with the only funding implication being the cost of extra doctors for a two week period to cover training for the practice.

The system is simple and effective. Patients call the GP surgery and give their basic details to the receptionist. Administrative issues get dealt with immediately, but the majority of patients receive a call back from a doctor within one hour, with most within 30 minutes.

During the telephone consultation, the GP determines whether the issue can be dealt with by phone, by face to face consultation or whether ordering investigations or sign-posting to other services is most appropriate.

The practice estimates only 30 per cent of calls result in a face-to-face appointment, and, as a result, the majority of patients – around 90 per cent – find it easy to get an appointment at a convenient time. The St Levant practice is one of 31 utilising this system.

This type of innovation improves outcomes and patient experience and manages the increasing demands on GPs. While it may not be for everyone, it will work in other situations, alongside IT solutions such as email consultation.

These together with the many examples showcased at the Improving General Practice – A Call to Action event last week, show just what can be done.  Giving those at the coalface the freedom to take a chance, do things differently, to innovate and do something new can lead to dramatic improvements in patient care and the job satisfaction of GPs.

We need to hear more of your ideas – how can we support innovation and achieve it at scale for the benefit of all patients across the country?  We need you to get involved in your call to action.

Dr Mike Bewick is Deputy Medical Director at NHS England.


  1. Keith Marshall says:

    This is all well and good, and we need to applaud the empowerment of NHS workers — from the lowest to the highest. But it is still the medical profession existing in a silo and believing they know what is best for everyone. The NHS has to wake up to the fact that it is a service provider (albeit with a monopoly) and like all service providers realise that it has to provide hat the customer (patient) wants. That means service improvements and innovations must be what we, the patients, want and it has to be patient led — not professional led. What does this mean? Basically it means that patients must have a majority voice on every decision-making body — and not just as advisors. Yes there is already patient representation in many areas, but it is only a minority voice providing advice and lobbying with the medics in the majority and making the decisions. The tables have to be turned so that patients are (just) in the majority with clinicians providing the advice and guidance. Both parties have to have full (voting) rights. Until this happens we are not going to see the paradigm shift which the NHS needs to undergo because at the end of the day the clinicians will mostly vote to stay within their comfort zone.

  2. Duncan Chambers says:

    Is there any rigorous research on the effects of ‘doctor first’-type sysytems for routine appointments?