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GPs go forth

DH 'told workforce review to ignore GP numbers'

Exclusive A major review of the primary care workforce was asked not to make any recommendations on GP numbers, as the Government has claimed it was not needed.

The chair of the review has told Pulse he was told not to focus on GP staffing levels following discussions between the Department of Health and Health Education England, who commissioned the report.

This was despite the health secretary at the RCGP conference in October last year promising the review would be an ‘independent study’ on what GPs were required ‘area by area’.

The DH told Pulse that staffing data were published last month on the NHS England website - although Pulse has reported there there are concerns around the accuracy of these data, and the GPC has called for them to be withdrawn.

Mr Hunt made a pre-election commitment that a Conservative government would create an additional 5,000 new GPs – a commitment he has since rolled back on, saying it is now only the ‘maximum’ that will be recruited.

The Primary Care Workforce Commission report, released last week, made a ‘note’ of this committment, but made no concrete recommendations on the GP workforce.

Instead, it largely focussed on recommending other non-GP roles - such as physician associates or pharmacists - who could ease the pressure on GP workloads.

In an exclusive interview with Pulse, the chair of the commission, Professor Martin Roland, professor of health sciences at the University of Cambridge, told Pulse that the number of GPs was ‘never in our terms of reference’.

He said: ‘There was a lot of discussion about whether at ought to be, or not, and a decision was made – not by me, between Health Education England and DH - that that was not going to be part of our terms of reference.’

He added that simply recruiting 5,000 more GPs was not enough, and that they should be targeted at underdoctored areas and given more than financial incentives to stay.

He said: ‘That means providing doctors with a feeling that they will get good working lives, that they won’t be isolated, that they’ll be supported and there will be good ongoing education and opportunities.’

When questioned by Pulse, Health Education England said the review had deliberately not been tasked with looking at GP numbers.

A spokesperson said: ‘It is important to look first at the new models of care that will deliver services that patients will want and need in the future before we look at specific numbers of any part of the workforce.’

A Department of Health spokesperson said: ‘As part of the secretary of state’s speech on general practice, clinical staffing data was published on the NHS England website last month detailing for the first time the number of GPs per area. Further work will follow.’

Dr Richard Vautrey, deputy chair of the GPC, told Pulse: ‘The promise made by Jeremy Hunt wasn’t followed through in practice. The data he wanted hasn’t really existed since the days of the Medical Practice Committee that was disbanded years ago.’

Readers' comments (36)

  • This should result in immediate sackings within HEE.
    To allow a review to be used for political expediency is a serious misuse of power and resources.

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  • " A major review of the primary care workforce was asked to make any recommendations on GP numbers"

    is there a "not" missing from that sentence?

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  • This has now been corrected

  • Dear All,
    "It is important to look first at the new models of care that will deliver services that patients will want and need in the future before we look at specific numbers of any part of the workforce.’"

    so we base the entire edifice on an assumption that something new will work even without any evidence it ever has in the past.

    This really is becoming delusional.
    Regards
    Paul C

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  • If you look at this through the privatisation lens then it is clear that primary care will be replaced by American style health maintenance organisations . The number of Gp's doesn't matter because general practice doesn't matter . That is why it is deliberately deprived of funding .

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  • Jeremy Hunt's promise of 5000 more GP's was never serious . Even if you could find adequate numbers of gullible students there aren't enough trainers .

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  • The american health care model does still depend on GP's , their model is different but it is more expensive as it is risk based.

    One of the drivers in the USA for reform is recognising that unless they reduce the cost of healthcare even the middle classes will not be able to afford health provision.

    Our issues are that we have ideologically obsessed politicians who love the idea of private health care - regardless of the cost or impact

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  • The final nail in the GP coffin? if any one had any doubt that the government do not care for our training, our sanity or our ability to provide healthcare safely and effectively for the local population, I hope you see the facts now. Thank you to the RCGP and the BMA being on our side and protecting our interests, rather than the interests of the patients which we do as GP's (if there will be any left in 5 years) ourselves very well anyway.

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  • The final nail? No we're six foot down with earth being shovelled on top. RIP.

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  • Agree, GP's have been taken off the endangered list to be put on the extinct notice board. Children will now go to the Science Museum to see what it was like to have had your own personal doctor in the bad old days.
    Future: Every area will have a Primary Care Center, run by nurses, staffed by nurses and others, with compulsory rotation posts for junior doctors and compassionate retirement posts for senile doctors.

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  • Ivan Benett

    What a gloomy lot of comments. I wonder if anyone has actually read past the headlines. The vision the Workfoce Commission has outlined is entirely consistent with the joint BMA and RCGP workforce paper published in January this year. Although numbers of GPs nurses etc were not in the remit, it is quite clear that there will need to be a substantial increase, and huge investment. However, in order to argue for the increase we need to have the vision. This report is a great start and the recommendations are thoughful and practical.
    For those apparently writing off GP, look again. This is about revitalising General Practice, developing teams around a practice list, and focusing on individual care.
    General Practice is alive and well, but needs to change to meet the challenges of the future.
    This document is a useful contribution. This vision is the way to avoid, rather than hasten, an American Style system.

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  • without knowing the numbers of practicing Gps on workforce,depleted by NHS Efficiency and stubborn;with GPs enforced to reduce appointment times to ten minutes,and demanding 7 day opening all this looks like a pipe dream.
    NHs has been actively depleting workforce numbers by irrationally referring,for mistakes of services the GP and doctors, to the obliging GMC MPTS thereby ensuring their resignations

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  • Ivan - please stop your politics

    Please explain how you can have a review of general practice without considering the number of general practitioners..?
    How can you have a review of any workforce without considering the very members of that workforce that do the job and are ultimately held responsible?

    Life is getting tougher for us all - those of you, like Ivan, who have been lucky enough to be at the right place in the right time and make the right investments and have stakes in various private firms, or come from more privileged backrounds are lucky - should stay quiet if you cant do anything for the grassroot GP

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  • Ivan,

    You are correct about probable future consideration for increasing GP numbers.

    However,

    General practice alive and well?? You've obviously being practicing in a different planet from rest of us moaners.

    Also how did Mr Hunt managed to come up with "5000 GPs" if he has not already done future scoping? Are you trying to tell us Secretary of the state simply plucked the number out of thin air without an analysis to back up his claim for need?

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  • Ivan I've been trading your comments over a number of years now, your position is a simple political one and always the same - ' I support the governments plans'

    Salaried GPs - 'yes please!', 7 day working - 'bring it on! doing it already!'....the latest government sponsored - 'smashing!', anything and everything happening is a great idea and certainly for the best.

    Do you have anything to contribute other than..'I think the government are right (on what ever issue is currently being discussed) ?'

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  • ''General Practice is alive and well''
    Ivan, your comments are quite enlightening and it is great that while we all are sailing in troubled waters, at least you are positive and think that BMA and RCGP do represent GPs and that there is a 'vision' we are heading towards. Unfortunately, majority of us don't but then opinions differ depending on what sort of resources you have access to or are sitting on.

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  • And on Friday Maureen Baker sends out a letter to RCGP members "Buildibg a work force for our future.".

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  • Ivan is having an hallucination rather than a vision . Dr Pangloss or what?

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  • i think in desperate times, GP's should cluster around viable areas, there are still very good practices with good earnings dotted all around ( Usually in the SE of England though) where I think they can build a sustainable future.

    Some areas have to become bare zones before people wake up and realise what they have lost

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  • these sound like third world politicians.desperation?

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  • Took Early Retirement

    I cannot understand why Ivan is so optimistic, though I like his thoughtful posts. It is good to have a variety of opinions here.
    I have to say I much prefer retirement to being a GP. This am I was chainsawing down a tree for my wife's cousin; so much more fun than doing a surgery of c 18-20 punters, 10 phone calls and then 3 visits, followed by almost the same in the evening.

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  • I agree with John Glasspool and Sanjeev Juneja. Ivan Bennett deserves credit for sticking to his vision and making his arguments thoughtfully and critically.

    At least he has engaged in debate with jobbing GPs which is something the chairs of the RCGP and GPC never seem to do.

    Whilst Ivan hasn't won me over with his vision of future general practice, I value an alternative opinion. We are not robots and don't all have the same view. His enthusiasm (if taken at face value) is genuinely refreshing.

    Ultimately, GPs are being herded into a future that is the assembly line of medicine. It will affect the optimists as much as the pessimists. Why must the debate always be a) accept and embrace government changes b) resist and keep the status quo?

    Just once it would be nice if there was serious analysis of option c) which would be to have semi-private NHS primary care.

    Disillusioned GP Partner

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  • What planet is Ivan on?
    GP is most certainly NOT alive and well on the whole. Please take note this is an opinion based on observation and this finger in the air method should NOT be used by Government when figuring out the future needs of our workforce.
    Can you at least acknowledge, Ivan, that many GPs will disagree with what you are saying based on their current experiences? Ideally a non political answer would be preferable.

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  • GP is all hunky-dory........
    http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/under-pressure-gp-practice-issues-letter-asking-patients-to-bear-with-us/20010611.article#.VbZUg7NVhHw

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  • exactly correct 1 .34 pm...the idea of a vision always suggest delusional tendencies...hallucination is more like it.
    Howver wacky and lacking in pragmatism Tory policy is, there is some vested interest who will support it... the memory of those fellas rowing a sinking boat on the Thames comes to mind....even when it was going down...on they went

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  • Just change the GP contract to payment per consultation like everywhere else in the world. No other country runs primary care on a fixed budget. Why are we the only country in the world that has such a crazy system that can offload huge quantities of work on to primary care for no extra payment. This is what the GPC should be campaigning for.

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  • Vinci Ho

    'Everyone is drunk and I alone am sober.' A Chinese saying. Then again , is it actually the other way round?
    May be this is part of a political mission:...

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  • Vinci Ho

    As I always say , ' it is a fine line between poiitically correct diplomacy and dangerously flawed hypocrisy.'

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  • /Hi Ivan Would be good for you to come to my practice.I have been a GP for 30 years and have seen the erosion of general practice. When I first joined very few patients went to hospital-something the government wants to avoid but this has to be paid as it was in the 1980s with an allowance for taking on a new partner which was not a one off payment. This payment meant we could take on more partners and patients would have better access and avoid hospital admissions. More and more young doctors only want to do locum work as the PARTNER in general practice is no longer valued. Think about it!!!

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  • come on guys leave ivan alone!!!

    yes you might not agree with what he says but I like seeing his comments on here, they usually make me laugh, in fact what I actually do is when I see his pic on the comments section, I put my hand over the comment and try to guess what he'll come out with next and more often than not im right!!!

    its like my dose of fox news, it makes me laugh. it sure beats smacking your head against a brick wall whenever you see a comment from mr hunt on the nhs!!

    give the guy a break; every profession needs a jester, and hes got the guts to come on here as himself!!

    we may not agree with what he says but I for one would miss the controversy he sparks if he left..... so lets keep him here

    ivan mate keep it coming!!!!!!!!!

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  • Vinci Ho

    'Oh, you. You just couldn’t let me go, could you? This is what happens when an unstoppable force meets an immovable object. You are truly incorruptible, aren’t you? Huh? You won’t kill me out of some misplaced sense of self-righteousness. And I won’t kill you because you’re just too much fun. I think you and I are destined to do this forever.'
    Who said this?

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  • This is hilarious - not because it shows competence, or good news, but because if provides clear proof that HMG have been as blinded and utterly out-played as we have by them. The Government think that starving the proffession of GPs will enable them to privatise it and shift it into the big American dream. Well done.

    But what they don't realise is that the Americans know that GPs are the most costly individuals, and the most efficient way of delivering care. By removing them you can pay a lot less, and yet generate tons of rework activity with enormous additional charges - so you increase profit both ways.

    What is more, we'll use CQC and scale to ensure we have only a few providers who the market is solely dependent on. Then they will be deemed 'too big to fail' and allowed to get away with murder and be bailed out for it - much like city financial institutions.

    The lunatics are really running the asylum now.

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  • @ 6.40pm

    Because the BMA has been hijacked by one eyed lefties who think its the BMA's role to campaign for the NHS at any cost, environmental issues, sugar in fizzy drinks etc NOT to be a doctors unions even though it is paid for by doctors.

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  • Ivan Benett

    Whoever said I should acknowledge that not everyone agrees with me. I acknowledge, never dobted it...read these comments pages! Not everyone thought the NHS was a good idea when we started it!

    The comment from the doctor who has been in practice for 30 yrs, well so have I, and remember working weekends without a break, getting up in the night to visit and doing a surgery the next day. Being at the side of people through the night in their last hours, and helping make cups of tea while women laboured all day. Claiming money through the old 'red book' system. Assistants being exploited. 24/7/365 responsibility. Those were the days! That. Was a different planet.

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  • I think Ivan has made a valid point - it's about vocation. We need to get back to 24/7/365 responsibility - it's the only way to make General Practice credible again. I think that sadly a lot of doctors regard General Practice as a career and feel they can work part-time, opt-out of things, go on holiday, have a family etc. We need to target recruitment to let the future generation know that General Practice is a 24/7/365 vocation not a career. They need to forget about pay, family life, or themselves and devote themselves to their patients. I'm sure Ivan would gladly work for free if it would help the cause but he like many others is constrained by being forcibly paid a salary. We should also look at cutting pay and changing T&Cs as that saving could go back into the NHS to pay for badly needed management consultants and more analysis of ways we can re-organize the NHS again preferably by folks who don't work in the front line as they know how best to do things. Thank goodness we have a conservative government who are already looking into this, I look forward to the forced contract changes that the right honorable Jeremy Hunt will impose - I am sure in the end the BMA will let it happen as they know not to rock the boat.

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  • Anonymous | Salaried GP | 31 July 2015 11:39pm

    I don't think 24/7/365 is enough. That's far too slack.

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  • Ivan

    whilst I agree that you are entitled to your opinion, and that opinion is welcome here, I disagree with your interpretation.

    This report is not a "great start" as you have suggested. It is simply the govt trying to sidestep the headline generating, public perception damaging problem of GP recruitment.

    It is a start, but the whole situation could be avoided if primary care was treated with some respect.

    Unfortunately that feeling is not felt throughout the country.

    Greater Manchester has not fared particularly well, with this year's recruitment less than 70% across the deanery.

    Furthermore, your primary care "standards" seems to be only adding further tickboxes, replacing the awful LES and DES already in place.

    Yes we are thinking negatively. However this is not unexpected and until there is understanding from CCG/govt level, there won't be any enthusiasm or cooperation from ground floor level.

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