FPM's Secret Diarist (and recently retired practice manager) gives their thoughts on a possible end to the 8am scramble, and recent votes in Parliament on NI changes (written prior to announced abolition of NHSE). 

Recent NHS Developments: Key Changes and Challenges

There have been a number of announcements recently concerning changes within the NHS, with the most publicised being a newly-agreed contract between the NHS and the BMA, which has seen funding increased by over £900m per year.

While this funding increase includes some encouraging changes, certain statements have been presented in a way that may lead to public misunderstanding, resulting in further criticism of GPs Surgeries, when the reality does not quite align with expectations.

The 8am Scramble: Unrealistic Promises?

One of the most debated aspects of the changes is the expectation that this new funding will eliminate the infamous “8am scramble” for GP appointments. There is an assumption that patients will now be able to book online, and see the doctor of their choice with ease.

While this sounds ideal, the reality is that this will not happen as promised. Patients are being given false expectations, and when these do not materialise, GPs will likely face further unwarranted blame.

Many GP practices already operate effective systems, such as full eConsult triaging. This allows an on-call doctor to prioritise urgent cases for same-day appointments while scheduling less urgent cases for a later date. In my experience, this system works well, both in my own practice, and as a patient using my GP surgery's services.

If surgeries are required to allocate a set number of appointments for online booking each day, it could disrupt an already well-functioning system. Patients may be led to believe that an appointment will always be available on the same day, even when it is not clinically necessary. Without additional doctors in practice, this change could simply redistribute existing pressures rather than resolve the root issue.

Financial Considerations: Is the Increase Enough?

The announced 7.2% increase in the capitation payment is a welcome adjustment but is unlikely to be sufficient to cover rising costs. The large increase in the minimum wage, along with changes to National Insurance contributions on lower earners i.e part time workers, (including its rise to 15%), will place significant financial strain on practices.

This is particularly affecting reception and administrative staff, who are often on lower salaries. These cost increases will add to the daily financial pressures of running a practice. Additionally, the narrowing wage gap between different staff groups is causing growing discontent within practices.

On a more positive note, changes to vaccination payments, the retirement of certain QOF targets, and adjustments to ARRS staff payments within PCNs represent steps in the right direction.

The Lords and the NI Vote

In a recent development, the House of Lords voted against the proposed National Insurance increase for health and social care workers, sending the proposal back to the House of Commons.

While it remains unlikely that the increase will be overturned, this move signals that politicians may be beginning to acknowledge the real-world impact of their financial decisions. Scrutinising such proposals is essential to ensure that policies support rather than hinder the NHS workforce.

NHS Leadership Changes: Amanda Pritchard Steps Down

Amanda Pritchard's decision to step down as Chief Executive Officer (CEO) of NHS England has been met with mixed reactions. She recently faced criticism from a Commons Select Committee regarding her handling of NHS changes, with some questioning her suitability for leading the next 10-year NHS plan.

However, it is important to remember that NHS leaders operate within the constraints set by the very politicians who later critique their performance. Any individual in this role will face immense challenges in trying to meet the expectations of all stakeholders. Under the circumstances, Pritchard has managed her role as well as could be expected.

Final Thoughts

While the recent NHS funding announcement brings some positive changes, unrealistic expectations around appointment access and financial pressures on practices remain key concerns. Moving forward, policymakers must ensure that decisions are both practical and sustainable to truly support frontline services rather than shifting burdens without real solutions.