Behind the headlines: Can Allison Pearson save general practice?

Rhiannon Jenkins analyses whether or not the Telegraph columnist’s seven-point plan to free up GP appointments stands up to scrutiny

For many Pulse readers, the name Allison Pearson will raise a few hackles. Ms Pearson credits herself with ‘starting the campaign to get GPs to see patients face to face’.

In August 2021, the Telegraph columnist said that she is ‘not surprised’ [by the] ‘torrent of abuse’ towards GPs by patients who could not get an appointment. Covid let ‘GPs improve their work-life balance while worsening the life-death balance of everyone else’, she opined. The BMA and RCGP wrote to the Telegraph to complain about the ‘completely unfair’ column.

But has Ms Pearson suddenly seen the light? In a recent column on the newly published GP recovery plan, she dismisses the Government’s ‘policy gimmicks’, and shows rare sympathy for GPs, who are ‘already cramming in up to 60 patients a day’ and ‘working 11-to-12-hour days’.

Sadly, it is not a complete Damascene conversion. Here, we analyse the good, the bad and the ugly of Ms Pearson’s own seven-point plan.

THE GOOD

‘Cut bureaucracy’

The first point in her plan is that ‘the vast amount of pointless form filling and data collection’ should be scrapped, as this ‘byzantine layer of bureaucracy’ seems ‘designed to prevent patients getting a hospital appointment’. Most GPs would agree, and the Government seems in favour; primary care minister Neil O’Brien recently told Pulse that the GP recovery plan will apparently free up to 15 million appointments in the next two years by cutting bureaucracy.

‘Abolish GP revalidation’

Ms Pearson described the GP revalidation as ‘a typical bureaucratic over-reaction to the Harold Shipman scandal’. This isn’t quite right – while it was certainly accelerated in 2000 after his conviction, it was first proposed in 1998. There is little evidence that revalidation has had any significant benefit, though. GMC figures from 2017 show less than 0.5% of revalidated GPs provoked concerns serious enough for the regulator to threaten withdrawal of their licence.

Yet Pulse revealed in 2018 that GPs invest an average of 55 hours a year in preparing for their next appraisal. As Ms Pearson pointed out, this demand ‘drives many good doctors into retirement’.

‘Allow private GPs and consultants to access a patient’s NHS records’

Admittedly, we are stretching the definition of ‘good’ here. Ms Pearson said it is ‘absurd’ that personal health data is ‘jealousy guarded by the state’, and this can indeed cause complications for patients who wish to see a private GP or consultant – especially those who have complex medical histories, as they cannot give an accurate account of them. There is a kernel of a point here; the sharing of patient records between NHS secondary care and GPs could definitely be more efficient. But even here, Ms Pearson misses the point – focusing on the tiny percentage of the population who access private health as their first port of call.

Ms Pearson also asked whether we really need a GP referral before seeing a consultant. The answer is, yes, absolutely. GPs manage 90% of problems and, in their gatekeeper role, only send on those who ‘need’ secondary care services. With open access, everyone who ‘wants’ consultant opinion (ie, everyone) would be able to do so and secondary care would collapse.

THE BAD

‘Introduce a charge for missed appointments’

This idea was initially pledged by Rishi Sunak as part of his Conservative leadership campaign; the Prime Minister wanted to charge patients £10 for missing GP appointments but he soon abandoned the policy following pressure from GPs and NHS leaders. 

There are some GPs in favour – a Pulse survey in 2019 found that 41% supported the idea. But others pointed out it would threaten the principle that the NHS is a free service at the point of need, likely affecting vulnerable patients the most. Let’s not forget the added layer of bureaucracy that would come with the policy, either.

‘Sack 70% of NHS managers’

Ms Pearson thinks that ‘no one will notice’ if nearly three-quarters of NHS managers were sacked. But given that the NHS is the single largest employer in the UK, it needs managers to ensure that it is able to provide high-quality services, especially in the face of growing demands for care. Her suggestion to use the savings to ‘train up thousands more nurse practitioners to assess patients before they proceed to see a GP’ is all well and good, but who would oversee the reallocation of funds and training of new nurse practitioners?

‘Bring back the waiting room’

Ms Pearson described the GP waiting room as ‘the best and simplest form of triage’. But there is no evidence why ‘sit[ting] for hours and wait[ing] your turn amidst a tsunami of snot’ is a good way to run the service. Even ignoring the problems of infection control in packed waiting rooms, remote triage works fine – if sufficient staff are available. The shortage of staff is the issue here.

THE UGLY

‘Get control of immigration’

Sadly, this is not a new idea, and it plays on perceptions that immigration can put pressure on public services. But research suggests that immigration has a positive impact on the NHS.

First, the contribution of overseas nationals is essential to the NHS workforce. Recent statistics by the UK Government revealed that one in six NHS workers in England reported a non-British nationality. The proportion of non-UK staff is also higher for doctors (32.6%) than for staff overall (16.5%). And we will need more overseas workers in the coming years, not fewer.

Second, overseas nationals are not just healthcare workers, but also taxpayers. This means that they pay for public services, including the NHS, just like everyone else. Getting ‘control of immigration’, as Ms Pearson suggested, would make it harder for people from overseas to join the NHS workforce, and this would be catastrophic.

While Ms Pearson seems to have softened her stance on GPs, her proposed policies for freeing up GP appointments are mostly bizarre and out of touch.