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GPs go forth

NHS England 'almost burying head in the sand' on GP workforce crisis, admits director

The deputy medical director for NHS England, Dr Mike Bewick, has admitted that they are ‘burying their heads in the sand’ on the GP workforce crisis.

Speaking at an NHS England ‘Call to Action’ event organised by Newham CCG and the London area team, Dr Bewick said the GP workforce problem was probably ‘the most pressing issue’ the NHS faced at the moment, but refused to link the problem to any erosion of pay.

It comes as NHS England last week rebutted calls for GPs to be given a pay rise above 1%, stating that there are ‘no compelling issues’ with recruitment in supplementary evidence to the GP pay review body, which had previously pointed out that there were problems with recruitment of salaried GPs in many parts of the country.

Answering questions from the floor at the NHS England event, Dr Bewick said there were ‘three elements’ of the GP workforce issue: ‘I think it one of the most pressing problems that we probably have and we are almost burying our heads in the sand. I think there are three elements of this… we are certainly not training enough, and I don’t think we are training enough that are going to be working full time.’

‘The second is about retention and we have got to do something to ease the burden. With the contract changes, one of the elements that we tried to pick up on was to reduce the burden and give headroom. It is a small token but I hope to keep you signposted on where we are going, into more broader outcomes rather than specific, granular outcomes, which will take away the burden.’

He also pointed to difficulties returning GPs, which is a priority of the new RCGP chair, Dr Maureen Baker.

Dr Bewick added: ‘Third, it is about bringing back people into the workforce, making it easier for people to return. We are looking at methods to do that.’

He also reiterated that NHS England intends to ensure that the right people become GPs, a point previously stated by NHS England’s head of primary care Dr David Geddes in an interview with Pulse.

Dr Bewick said: ‘Workforce planning… in this country, it really isn’t something that we are good at. I think that we are not actually choosing well at the basis of entry to medical school. We are not looking at people who want to serve their community as well as do medicine, and I think that we need to go back to the beginning of choosing of doctors because most of the reasons for why people are going into this has nothing to do with their local practices. We have got to get something out there which shows what a really wonderful job this is.’

‘We have got to go out to the schools, and it might mean that we have to do more workplace programmes with younger people to show that this is where you want to work for the rest of your life, because it is exciting, interesting and innovative.’

Speaking to Pulse about the issue of GP pay, Dr Bewick said: ‘The workforce issue is one about retention and recruitment. The issue about whether that is related to pay directly is probably very slim because we know people come into medicine for lots of other reasons other than just earning money. The issue that I think we have got to address is that many doctors are worried about the system at the moment and they are looking to leave it. We have got to make their workplace a better place to work in so that they don’t feel under so much pressure, and what we have been trying to do with the contract is to give them the headroom to do that.’

‘That was part of what I was trying to do today, to give them some confidence that NHS England is on their side to try and make change.’

Asked whether recommending a pay rise may have given GPs some confidence, Dr Bewick said NHS England would ‘rather’ GPs improved their model.

He said: ‘I’d rather we gave them resources to improve the service, which might actually decrease the amount of work on them. It would be very difficult in this situation, where you’ve got other parts of the workforce losing their jobs, and other parts of the workforce on virtually negative [pay development]. Particularly as GPs are not the worst-paid part of the system, I don’t think that would go down well with people in the health service who are on a more moderate pay either.’

NHS England has launched its ‘Call to Action’ to explain to professionals and the public why they think that primary care has to change its ways of working, and help CCGs shave £30bn off the cost of running the NHS. The call has been supported in research papers by the King’s Fund and Nuffield Trust, as well as the RCGP, which have said GPs must join together in federations for general practice to remain affordable and sustainable in the long term.

Readers' comments (30)

  • GPs may well not go into medicine for the money, but making the workload intolerable, spinning relentlessly against the profession and then reducing pay - especially seniority - hardly seems the recipe for retaining senior doctors. The last sentence also astounds me - the reason that our health costs are low compared to other countries like the US is because of Primary Care. Try without it and have unfettered access to hospitals and watch the costs rocket.

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  • Hussain Gandhi

    Don Berwick is right. People do not become doctors for the money. However the workload is crushing at present and getting worse. If the workload will not lessen (and it is unlikely to seeing as more things are being pushed to primary care) then asking for more pay is a way to highlight the amount of work we are doing and feeling remunerated for the work. That or leaving. Wait....that has already started.

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  • I feel the gate keeping role of the GP is unsustainable as errors of 'failure to refer' or 'avoidable death' etc usually human has meant explosion of no win no fee medical negligence businesses that is growing exponentially. Patients would need early and the right specialist opinions and management if you want not to be sued. GPs are at high risk and remain very vulnerable in this system although we come cheap!!

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  • Tom Caldwell

    So in short NHSE want the right people, want the right people to change their model, want the right people to make up for the awful workforce planning but don't want to give the right people anything in return (in fact would prefer to give less). Beyond capacity, expected to do more, expected to accept less..... they are not just burying their heads they a burying the NHS.

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  • Vinci Ho

    Since this speech is addressing to us specifically. I would like to see how many of us would vote to support or oppose what NHSE is doing to solve this problem in a ballot .

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  • Maybe NHSE should ask those of us who have resigned why we have done so?

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  • It's pensions stoopid, or specifically the life time allowance and the 40k max. per year. With pension contributions rocketing because of the banding we end up paying a colossal tax bill. 5 gps in early 50s retired in one small town of 40k patients- unsustainable and a complete waste of experience.

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  • 8.06pm agreed...... as soon as we reach our maximum allowed lifetime allowance we are all retiring.......simples......

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  • Not so simples......
    Most women who worked part time or took a career break will struggle to reach the lifetime limit and would go part time to avoid the yearly cap. Like me, they are leaving because of
    - constant GP bashing in the press
    - inexorable and unmanageable rise in workload
    - unmanageable rise in expectations
    - constant micromanagement and being forced to do stupid things which we do not believe help patients
    - total loss of autonomy
    - worsening and unacceptable work life balance
    - worse remuneration which makes above intolerable
    - being blamed by politicians for things outside our control
    - being set up to fail, and then blamed for the resulting chaos
    - yes, system changes which we do not believe in
    - creating dilemmas which cause tensions within partnerships ( eg do we go for income even if it is stupid or take a cut in drawings?)
    - the " progressive" tax system, in particular loss of personal allowance which gives massively diminishing returns for extra work and makes take home pay for extra hours lower than our staff.
    - the creation of an " us and them" divide between partners and salaried doctors which is increasingly bitter
    - fragmentation of the system with almost total lack of communication between consultants, community nursing teams, GPs, social services etc and a good dose of resulting distrust and disdain.

    The fact is that the job is not fun any more, the remuneration is NOT that good and the downside now outweighs the benefit for a lot of people.

    It is not just money.....

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  • What is not being discussed is inflation . since the contract in 2004 average inflation has been 2.7% . Compounded this is an equivalent of a 30 % pay cut by April next year. The pension is restricted to the CPI link . What is RPI over the last 10 years ? Not only are you working harder but what you earn buys a lot less .

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