Despite years of pledges to bolster the general-practice workforce, GPs and our teams are working to their limits, facing debilitating staff shortages and severe resource pressures, and patients are finding it harder to access care as a result.
In September 2015, the health secretary at the time promised 5,000 more GPs by 2020. Since then, the number of full-time-equivalent, qualified GPs in the UK has fallen year on year, plummeting from 29,364 in 2015 to 27,848 in 2021, a reduction of 1,516 family doctors on the front line, delivering care. Last year, we learned the current government is also way off track to deliver its 2019 manifesto pledge of an additional 6,000 GPs by 2024 – a demoralising blow to a profession that has worked tirelessly to respond to the Covid-19 pandemic.
As our workforce depletes, patients’ need for their local primary-care practice is escalating. On average, each GP is looking after nearly 200 more patients than they did in September 2015. Last year, including Covid vaccinations, an unprecedented 367 million appointments were made in general practice. And, in the last six months, the numbers of appointments delivered by GPs and our teams every month has exceeded pre-pandemic levels, with 25 million delivered in February alone.
Pre-pandemic, general practice was already under strain, caring for a growing population with increasingly complex health needs. During the pandemic, general practice ensured patients could access the care and services they rely on us for, in as safe a way as possible – and GP-led teams took a leading role in delivering multiple, complicated, mass vaccination programmes, with each jab protecting patients and offering a route out of the pandemic. Now, GPs are at the centre of their communities’ recovery from Covid, supporting 6.1 million patients in England on NHS waiting lists, and caring for those with ‘long Covid’.
Put simply, workload in general practice is surpassing levels which can be considered safe and sustainable.
In the latest National GP Worklife Survey by the University of Manchester, a third of GP respondents said they planned to leave front-line patient care in the next five years, many earlier than they planned to. These are highly trained, highly experienced family doctors lost to patients and their communities.
What was striking, and most depressing, about the survey was the high numbers of GPs under 50 planning to leave within five years. This isn’t all just about people taking early retirement; it’s a reflection of the exhaustion being felt, leading to GPs protecting both their own well-being and their patients from the risks of stress leading to mistakes.
GPs enter general practice to care for patients, and to care for them throughout their lives. The “joy” of general practice comes from being able to treat not just a patient, but their families – their elderly relatives, and their young children – building relationships with them, which in turn help us to instinctively spot when something isn’t quite right and to have that sensitive conversation about their health more effectively.
But this kind of care, which we know GPs and patients both value, and which evidence shows leads to benefits for the NHS, is becoming increasingly difficult to deliver, particularly when political focus consistently prioritises quick access and transactional care.
Being a GP is a stimulating and professionally satisfying career. I’m biased, but I’d say the best career in the world. But not when we’re on a conveyor belt, rushing through more patients than we can safely see in a day, without time to reflect on the care we’ve delivered – and not when we’re worried about what the latest headlines will say about how hard we’re not working.
We need more GPs, we need more colleagues working with us in general practice – but we also need more time with our patients.
There are more GPs in training than ever before, which is excellent news, but when more GPs are leaving the profession than entering it, we are fighting a losing battle.
Action must be taken by the government to keep trained and experienced GPs in the profession, including by tackling an “undoable” workload, starting by eliminating unnecessary red tape and bureaucracy that takes up large amounts of GP time that could be spent delivering front-line care.
One of the reasons we are where we are is the history of poor NHS workforce planning. We need to know how many doctors, nurses and other healthcare professionals we need in the NHS to deliver the care patients need now and in the future. Yet, the government recently rejected an amendment to the Health and Care Bill – an amendment supported by the Royal College of General Practitioners (RCGP) along with more than 100 other health organisations – that would support this by making it a legal duty for the government to publish projections of NHS workforce gaps every two years.
MPs have a second chance to support this amendment when it returns to the House of Commons in a few weeks’ time.
General practice is the bedrock of the health service, making the vast majority of NHS patient contacts and in turn alleviating pressures across the NHS, including in emergency departments. But we need enough people to be working in the profession to do this safely.
The government must stop opting for sticking-plaster solutions to address the fundamental and deep-rooted workforce and workload challenges in general practice, conditions which have only been exacerbated by the pandemic.
It sometimes feels futile to keep saying it, but it mustn’t because it’s necessary: the government needs to pull out all the stops to deliver on its 2019 election manifesto promise of 6,000 more GPs and 26,000 more members of the wider practice workforce by 2024, so that GPs and our teams can deliver the good, safe and appropriate care our patients expect and need, when they need it.
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