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The waiting game

Dr Krishna Kasaraneni: 'The powers that be are finally getting the message'

GPC training lead calls on politicians to set realistic targets when trying to solve the workforce crisis.

After years of pushing by the BMA and others, the media and the powers that be are finally getting the message: GP services are under unprecedented pressure and are struggling to cope with the incredible demand on them. Today sees the publication of an NHS England driven plan that lays out ten points to address the workforce problems bedeviling general practice – but will it be enough?

Firstly, and perhaps tentatively, let’s start with a positive. A few years ago, policy makers and NHS managers had their heads buried deep in the sand, denying there was any crisis in general practice and particularly with the workforce. It was an incredible state of affairs given the clear counter evidence on the ground. Finally though, not least because of the BMA’s Your GP Cares campaign and behind the scenes lobbying, a shift has taken place in the past 12 months. You can’t move at the moment in the media for promises of more funding for GP services and policy makers are constantly chattering about the problems facing GP practices, even if some like the CQC, continue to miss the point and heap unfair blame on GPs. 

This new plan, heavily influenced by the BMA and others, also recognises that there is a specific problem with the GP workforce, both in terms of recruitment and retention. Last year was a nadir for both: a significant number of GP trainee positions were left vacant – as many as 400 in the first round – and seven out of ten GPs told the BMA in a survey they were thinking of retiring early. The simple result of this is that with fewer GPs, there will be fewer appointments for patients and shortage in services. Everyone loses.

However, as many GPs will know, words are one thing, translating them into actions on the ground is something else. Does this plan, full of more warm words, move us any closer to this?

Establishing a new scheme to encourage GPs who may be considering a career break or retirement, to remain working on a part-time basis is a very positive development.  The proposed new induction and returner scheme will go some way in acknowledging the different needs of those returning from work overseas or from a career break.

However, while these developments are encouraging the BMA is not getting carried away, and neither should any GP. Implementation on all of this will be key and as yet, this has not been fleshed out. There are also many, many issues beyond the scope of this paper that we do not have clear direction on and which need to be addressed before general practice can truly be said to turn the corner. The promised £1.2billion for GP infrastructure remains unassigned and vague. Wider GP services are continuing to struggle and politicians of all parties have not realised that they cannot keep bombarding voters with promises that are undeliverable, whether it be 48 hour targets for GP appointments or extensive, longer opening hours for practices.

To answer the question at the start of this blog, the plan on its own is not enough. But it is an encouraging step forward that, from this day forward, the BMA will be working with and consistently challenging policy makers to turn into practical, deliverable solutions that will make a long term and sustainable difference to GPs on the ground.

Dr Krishna Kasaraneni is chair of the GPC education, training and workforce subcommittee and a GP in Sheffield

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Readers' comments (11)

  • Sorry to pour cold water on your sincere enthusiasm, but none of the recent announcements will make a jot of difference in the medium term.

    Until someone addresses the core issues of the Carr Hill formula not rewarding GP workload, the myriad changes to NHS pension scheme, the changes to rules about practice boundaries, and the relentless demands of the worried well on a stretched service, general practice is going to fail before any of this high faluting talk turns unto action.

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  • I agree with above comment. We are under-doctored and under-staffed. If you want to meet the demand for consultations which only goes up year on year, you need smaller list sizes per GP. And don't say the work can be delegated to other health professionals. Some tasks, yes. But until other professionals take more responsibility for pt care the problems land back at the GP's door. So, currently we need no less than 1.5 GPs for every 2000 pts. Practice income to meet this needs to be at least £130 per pt. No-one will want to enter GP until this is seriously addressed.

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  • I fully agree with Dr.Wheeler and the anonymous practice manager. Delegate work to whom?. Finally the buck stops with the doctor. We all come across patients who go the pharmacists and are told to go to the GP to get antibiotics? All other health care prof including the hospital doctors, social workers, health visitors etc; do this. See your GP

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  • Far too little, far too late. I'm fed up of busting a gut to get through a day, made impossible by political interference. At thesame time the politicians stoke demand and encourage litigation while the press constantly villify us. All the fun is gone, no goodwill left. Getting out ASAP.

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  • I am currently finding it very difficult as an experienced GP to move to an English Performers list from Scotland . It is unlikely all the paperwork will be through from NHS England to start my new post in April- if this level of bureaucracy is in place for currently practicing doctors I can't imagine the barriers to returning to practice!

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  • Hopelessly inadequate response.
    Nothing about reducing workload.
    Nothing about the deluge of pointless bureaucracy.
    We are doomed.

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  • Krishna I admire your tenacity old chap but the simple problem is summed up in the first few words of your headlines......."the powers that be" who aren't grass roots GP's control things!!

    It is almost 2 years to the day that myself ( a 31 year old newly appointed GP partner ) and my wife a similar aged salaried doctor emigrated abroad! Between us we had over 60 years to give to the NHS and would quite happily have done so, had the system not been so totalitarian. Abroad we "call the shots"! We open and close out clinic when we choose, we are able to select our patient population, we can choose the type of work we wish to undertake , we are not obliged to cover home visits or nursing homes although we can do should we so wish. The scope of practice is greater- can work in hospitals, A&E, drug addictions and rehab if we want and get paid extremely well if we do. The pay is greater and we are paid per consult and the taxes are lower, so what is left in our pocket is far greater. The patients are extremely respectful and understanding , the media are supportive and as recent immigrants we have been made to feel at home from the moment we landed. There is no CQC, revalidation and unnecessary organizations like CCGs. Our unions and leaders actually represent us here too. Contracts are enshrined in law and cannot be unilaterally amended by the government without consent of doctors. Funding is transparent and easy to understand .

    Quite simply out here we are "the powers that be" and not some bureaucrat who has no experience or business pontificating how I should practice!!

    So it seems quite obvious to me that the message is not getting through to those who make decisions because I haven't seen any of them resign or lose their jobs and get since I have made the move no fewer than 10 of my GP friends, colleagues and associates have followed me with more on the way in the future!!

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  • This makes my blood boil, it really does. So while other Royal Colleges speak up in the media such as Peter Carter (RCN), this video which looks like a sixth form media studies project is released. Glad I cancelled my RCGP membership last year, I do not wish to belong to this college which no longer represents reality we face.

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  • The only politicians who seem to have got the message are UKIP, who are promising to end Revalidation and abolish the CQC.

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  • Sadly it is felt by most doctors that the BMA/ GPC leadership are only interested in getting knighthoods. They do not truly care about their workforce and the results are plain to see.
    We have been here before. They give you a few pound today, then they take it away tomorrow. Witness MPIG, pensions,pay. On top of this, while we see over 90% of consultations on 8% of the budget, the Health Secretary states that A+E doctors who do 1% of consults] know patients better than their own GP. This statement is patently untrue from mathematical fact, so when a Health Secretary makes untrue statements to denigrate a whole profession and then imposes a Contract [ it is absurd logically to have an imposed Contract] - the message is clear - it is best to leave the profession as soon as you can. What he did yesterday, he can do again tomorrow.

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