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CAMHS won't see you now

Why Hunt's pre-election promise of 5,000 new GPs is a long way off

The health secretary should be very concerned about his pre-election promise, find Jaimie Kaffash and Alex Matthews-King

Office worker with speech bubble 3x2

Office worker with speech bubble 3x2

‘I can today confirm plans to train and retain an extra 5,000 GPs,’ health secretary Jeremy Hunt told cheering delegates at the Conservative party conference in 2014. But the applause is now sounding rather hollow.

A Pulse analysis of workforce data reveals that if current trends continue, just 2,100 new GPs will be delivered by 2020. And that is a best-case scenario; there are looming storm clouds that could knock even this optimistic projection off course. It does not factor in the harm done by the junior doctor contract dispute and any further damage to GP morale. It also assumes that more UK-trained GPs can be attracted from abroad – an unlikely prospect.

Nevertheless, if Pulse’s estimate proves accurate, this would be a disaster for the Conservatives’ entire pre-election plan for the NHS. General practice needs at least 5,000 new GPs to stand still and there will not be enough GPs to provide seven-day access or lead on the £10bn plan to produce ‘new models of care’.

Estimated changes in gp numbers by 2020

Estimated changes in gp numbers by 2020

On every front, health education chiefs are floundering. A 10-point plan to increase the numbers of GPs in training and bring back returners is – based on current trends – likely to bring in just a few hundred extra trained GPs. Two years on from his pledge, Mr Hunt has still to introduce any major scheme to address the 1,400 GPs retiring every year, while hundreds are applying to take their much-needed skills abroad.

Whitehall mandarins are frantically trying to gerrymander the figures, rebranding Mr Hunt’s pledge as 5,000 ‘doctors in general practice’ (see box below). But even with the extra time that would give, it is difficult to see how the trend could be reversed. A Health Education England (HEE) marketing campaign featuring GPs signing forms to allow patients to go skydiving has dive-bombed. As Dr Stuart Sutton, former chair of the RCGP’s Associates in Training committee, put it: ‘If the highlight of a GP career is signing skydive forms, I’m off to watch paint dry.’

And many other medical graduates agreed – with Pulse revealing earlier this year a 5% drop in applications for general practice.

But HEE has several irons in the fire for the next 12 months. It is introducing £20,000 ‘golden hellos’ for trainees to work in areas with poor recruitment – such as Blackpool and the Isle of Wight – and is planning a major review of culture within medical schools to ensure prospective new GPs are not being put off.

 Ongoing dispute

It is also introducing a fast-track scheme for applicants who score highly on the entrance exam to GP specialty training and the facility to defer starting training for up to 12 months.

But the ongoing dispute on the junior doctors’ contract could undermine this work, with many bright young people put off medicine altogether by all the adverse publicity about working hours. There are already reports of large increases in the number of junior doctors applying to go abroad to complete specialist training.

How the Government’s target has been diluted

The DH now claims that the target of 5,000 extra GPs by 2020 will also include doctors in training, effectively giving it three more years to boost numbers.

But this was not health secretary Jeremy Hunt’s original pledge to the Conservative Party conference. His words were: ‘Tory conference, I can today confirm plans to train and retain an extra 5,000 GPs.’

And this was the rhetoric leading up to general election, with the DH saying it was committed to bringing ‘5,000 more GPs’ into the system by 2020.

But this rhetoric changed when Mr Hunt announced his ‘new deal’ in June 2015. The health secretary also said in the subsequent Q&A session that there would be ‘flexibility [in the target] because in some parts of the country it is very hard to recruit GPs’.

On the other side of the scales, Pulse has obtained data from the NHS Business Authority that show the current rate of GP retirement in England is around 1,400 per year. Some may be tempted back part-time, but this still represents a huge loss when the country needs every GP it can get.

Pulse understands the GPC is close to agreeing a ‘retainer scheme’ that will see practices given more funding if older GPs are persuaded not to leave, and Pulse recently revealed that the Department of Health was training 160 ‘resilience’ coaches to help keep burnt out members of the profession working.

But, again, the Government has waited too long to address this problem and its ‘reforms’ to seniority payments and public sector pensions – in particular the cap on tax relief – are actively encouraging older GPs to consider jacking it all in.

A major BMA survey of 16,000 grassroots GPs last year found that one-third of GPs were thinking of retiring from the profession within five years. Burnout is a major issue, with a Pulse survey last year showing half of GPs were at risk, and despite promising comprehensive occupational health provision for all GPs, NHS England has failed to put any new support in place.

‘There is a risk whether we will be able to get that number of people into general practice. However, without that, it will be difficult to deliver our ambitions.’

Lord Prior, health minister

GPC education, training and workforce subcommittee chair Dr Krishna Kasaraneni says: ‘The political pledge to recruit 5,000 GPs by 2020 is wholly unrealistic. Pulse’s data analysis shows how short we are likely to be. We actually need a lot more GPs than this arbitrarily chosen figure to maintain a basic level of service to patients. With 600 GP trainee posts left unfilled last year and large sections of the workforce telling the BMA they intend to retire, there is little chance the Government will get anywhere near this target.’

Workforce experts endorse Pulse’s recruitment figures, but say there is work going on behind the scenes to ensure the 5,000 target is achieved. Professor Martin Roland – who authored a landmark review into the primary care workforce last month – says a ‘whole raft of measures’ will be included in the new ‘roadmap’ package for GPs next month, which will seek to implement his recommendations to broaden the skill mix to include physician associates, pharmacists and paramedics.

Professor Roland says of the Pulse figures: ‘The main problem I see is that you don’t take account all the efforts that are taking place to improve things – in particular things in the forthcoming “Road Map for General Practice” that NHS England will be publish in the next few weeks – which are designed to increase morale, recruitment and retention and make return to practice easier.

‘So yes, if things continue as they are you may be right, but there’s a lot of effort going into ensuring that they don’t.’

During the last parliament, the DH increased the GP workforce by 1,000 full-time-equivalent GPs and insists it is ‘on track’ to meet its target of 5,000 more doctors in general practice by 2020. A spokesperson says: ‘Pulse’s figures don’t take the whole picture into account.

‘NHS England and HEE are working closely with the BMA and RCGP on a 10-point plan which sets out exactly how we will achieve this. We have been clear that our target includes registrars.’

However, even ministers argue for caution. Lord Prior – the former CQC chair said in the House of Lords this month: ‘There is a risk whether we will be able to get that number of people into general practice. However, without that, it will be difficult to deliver our ambitions.’

Readers' comments (20)

  • Goverment does know and understang gp work load and how to look after them so stay in this country. Lots of sticks but no carrot.

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  • "fast-track scheme" - what? I thought we had near-universal agreement that GP training is too short as it is!

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  • I am one of those who retired early; Unrealistic demands, constant CCG disorganisation; inappropriate targets such as well person checks ( no clinical benefit) dementia "screening " (possible harms) the futile exercisee of appraisal and re accreditationsouped up with an expensive and wholly inappropriate CGC inspection and constant deprofessionalisation as a result of guidelines: It would take a lot to tempt me back even to do some locus sessions.

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  • I'm one of the (apparently few) GPs who have returned from abroad. The new Returner scheme was stupidly bureaucratic and took a YEAR! (After band 4 in both exams - the simulated surgery in particular was very dubiously marked). That's £6000 (after indemnity costs) income for a year. It's all nonsense!

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  • Hunt must rue the day he left the department of culture and media where life was easier doing favours for his chum Rupert. He only has himself to blame for the current mess.

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  • Despite my extended cynicism and gloomy prognosis over a period of many years, and having left full time GP for all the well-cited reasons, I just cannot believe that this is happening to general practice. When GP falls over, the next domino will be secondary care then the whole NHS. What are we doing to our NHS? Who will look after us when/if we need decent care?

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  • And why would this be?
    Because Jeremy and hid puppet master Dave have not resigned.

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  • Perhaps the fact that the UK spends almost the lowest proportion of GDP on health in Western Europe might have something to do with the problem?

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  • Nobody in Govt cares really. they have cut funding from 11 to 7% to a group who sees 90% of the consults.
    Mr Hunt has been forthright = Penance and neglect of GP land, he said.
    We GPs are the mugs, actually. We soak it all up and do more and more, while GPC hold meetings and conferences and speak to the media and get gongs.

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  • Peter Swinyard

    In all fairness, the other lot at the election were promising 8000 more GPs but both lots of figures were, um, unevidenced.
    The continuing downward movement of resources coming into practices is tearing the heart out of general practice. The recruitment crisis is such that many practices have just given up advertising as it is throwing good money after bad.
    The perfect storm of pensions caps, increasing pensions contributions, ridiculous indemnity costs and lily-livered MDO advice to roll over and apologise to patients for everything even when you have done nothing wrong and the inspection industry which has imposed a ridiculous precept on general practice which means that a practice with 4999 patients cannot afford to take one the next patient as it will cost them over £700 to do so - well it is an insane situation which will only be cured when we get some determination and resign en masse from the NHS contracts and then form chambers of practices and offer services to the NHS at an economic cost. Then we would inevitably see an increase in the proportion of NHS spend on GP rise from 7 to 14%.
    But will the cardies wear it?

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