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The moment of truth for rural GP services

A recent report by the NHS Confederation calls for a ‘re-imagining’ of the NHS if the service is to emerge on a stronger footing from Covid-19. A triple ‘whammy’ of rising COVID-19 infections, a major backlog of treatment, and reduced capacity due to infection control measures, will all conflate to put NHS providers at risk, it says. And, if providers are to emerge from the pandemic on a stronger footing, they will need extra investment and support for front-line services.

In the face of multiple local lockdowns as COVID makes its second pass, GPs once again find themselves preparing a pandemic response, as well as making good on their appointments backlog and preparations for what is expected to be an unprecedented rush for seasonal flu vaccination. It is, perhaps, reasonable at this juncture to ask how well enabled rural GP practices actually are to face the challenges ahead.

Perhaps, the most surprising development to come out of COVID phase one has been the way in which so many services have been transformed. In GP circles, this has seen face-to-face consultations change almost overnight into a digital- or phone- based service: according to the NHS Confederation, 71 per cent of routine GP consultations were delivered remotely in the four weeks to 12 April, compared with about 26 per cent face-to-face, reversing the pattern of the same period last year.

Rural volunteers and the kindness of staff have been mobilised in droves to support GPs with ensuring that their communities’ oldest, most fragile shielding residents continue to receive vital medicines supplies.

However, behind the success stories, perhaps, hide the longer-term challenges of delivering rural GP services. In the post-COVID world it is hard to imagine how these can be addressed: rural GP recruitment remains in a perilous state, putting further pressure on an already beleaguered and exhausted healthcare team; rural GP IT struggles on functioning at the mercy of unreliable rural Broadband or network coverage, and for rural GPs offering what some regard as a niche medicines dispensing service, the development time-table for the specialist 21st Century IT equipment they need has found itself pushed even further down the negotiating agenda. Even core payment for the GP dispensing service – a vital lifeline for many living in a socially-distanced world – is based on a system that is over 10 years old and which was never designed to take account of the extra costs and requirements of a pandemic, nor supply chain interruptions caused by the UK’s exit from the European Union.

The NHS Confederation describes the current time as the “moment of truth” for the Government and its stewardship of the NHS. Its report states: “Either [Government] embraces what we have learned in recent months and provides the support and investment the NHS needs to get back on track and reform for the long term. Or it continues with short-term fixes, bail-outs and ever-increasing targets and regulation that continue to stifle NHS staff from ‘locking-in’ [essential] changes.” Rural GPs may fear that the dice is already loaded in favour of the easier fix. 

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