We’ve heard pledges from all the major political parties over recent weeks to “restore the role” of the family doctor, to end the “8am rush” for an appointment and cut waiting times, to increase the number of GPs and reduce variation in services. General practice will clearly be a key battleground in the run-up to the next general election.
But highlighting current conditions – which are a result of the government’s failure to boost GP numbers as it promised to do at the last election, resulting in some of the lowest satisfaction rates with service access on record – often has the unintended consequence of making it sound like GPs and their teams aren’t doing enough.
In reality, it’d be hard to find a GP who is complacent about the crisis facing the profession and the impact this is having on their patients. For years, the Royal College of GPs has warned that there are not enough of us to provide the safe, timely and personalised care we are trained to deliver, and that patients rightly expect.
General practice workload is growing in both complexity and volume: advances in medicine mean we can do more for our patients in the community, and we are looking after a growing and ageing population with more people living with multiple, chronic conditions. But this is falling on fewer and fewer GPs. In England, we are delivering over 6.5 per cent more appointments per year than before the pandemic, almost half on the day they are booked, but with 824 fewer fully qualified, full-time-equivalent GPs than in 2019.
The result is unsustainable pressure. GPs are morally distressed by this situation, which is out of our control, and is leading many to leave the profession earlier than planned. The Royal College of GPs’ research shows that 70 per cent of practitioners say they are too stretched to guarantee patient safety. Our estimates suggest as many as 22,000 could leave in the next five years, with many citing stress and burnout as reasons.
It’s true we have more GPs in training than ever before, which is fantastic, but it will take several years for these doctors to qualify and join the profession. Likewise, increasing medical school places is absolute necessary, but the impact on the front line will only be felt in the years to come. In the meantime, more highly trained, experienced GPs are leaving the workforce than entering it – GPs that we need, both for patient care but also to mentor the younger, newly qualified GPs coming through.
[See also: More medical school places will not automatically create more doctors]
It’s absolutely right that general practice should be a priority for any government but what GPs, our teams and patients need to hear are radical but achievable plans to maintain and build the GP workforce, in the short and long term. This is, frankly, the only thing that will keep our service sustainable and improve patients’ access to care.
What we don’t need is for general practice to become a political football, with parties of all persuasions kicking around vote-winning promises about tougher access targets that will be undeliverable without addressing workload and workforce pressures. In some cases, what we’re hearing would exacerbate them.
One of the underlying reasons for the mess is a historic lack of NHS workforce planning.
Last week, the government published its primary care recovery plan, which promises many things including investment in telephony and training for staff to appropriately triage patients’ calls, expanding the prescribing role of pharmacists, and further cutting bureaucracy, allowing GPs to spend more time with patients. These are welcome and positive steps, but the only true solution to addressing the crisis is to increase GP numbers both in the short and long terms by training and retaining them.
We have been waiting for a long-term NHS workforce plan for years – most recently we were promised it would be this spring. But while we initially thought that general practice would be specifically addressed in it, we have heard worrying whispers that actual numbers of how many doctors, nurses and other healthcare professionals needed to keep the NHS afloat – and thriving – will be removed. Frankly, a workforce plan without numbers wouldn’t be worth the paper it’s written on.
How can we move forward without establishing how many people are needed to keep general practice and the wider NHS sustainable for years to come?
It’s vital that any modelling on future GP numbers considers the number of doctors that are planning to leave and works to address this. As I’ve mentioned, our surveys suggest this could run into the tens of thousands in the next few years. To avert this looming crisis, we need reinvigorated retention schemes that provide targeted support to GPs who are most likely to leave. This may be those considering early retirement to escape current pressures, but also those at other stages of their careers, such as GPs struggling to juggle caring responsibilities, and those just starting out who are daunted by the additional responsibilities of being a GP that aren’t made clear during their three years of training.
We desperately need less stick and more carrot from the government.
General practice is the bedrock of the NHS, with GPs and our teams making the vast majority of patient contacts in the NHS. In doing so they alleviate pressure across the whole health service. The model is not broken but it is struggling. Without a functioning general practice service, the NHS will fail. Patients, GPs and their practice staff deserve better.
We need to see more, and sustained, funding for general practice, including in our IT and infrastructure. We need to see more concerted efforts to reduce bureaucracy to give us more time with our patients. And crucially, we need to see robust plans to build our workforce and go beyond the 6,000 GPs that the government promised, and hasn’t delivered, in its 2019 election manifesto.
Sticking-plaster solutions are simply not enough anymore. Neither are promises and imposed targets without substance. Political parties of all persuasions need to listen, understand and act.
[See also: The NHS workforce crisis could be solved by reforming medical training]
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