This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

Gold, incentives and meh

Most GPs ‘drowning in work’, says NICE chair

GPs are ‘drowning’ in work and the Government needs to listen to their concerns that patient demand is unsustainable, the chair of NICE has told delegates at Pulse Live.

Taking the stage for an interview with Pulse editor Nigel Praities, Professor David Haslam said most GPs he knew were struggling with their workloads as demand in general practice continued to rise without any additional funding to match it.

Professor Haslam said: ‘I know most of the GPs I meet are struggling, they are drowning in work and the constant never ending demand and the feeling they can never get on top of it.’

He added: ‘We have to find a way of supporting them as well as ensuring GPs get the best quality care.’

Professor Haslam said the narrative on what patients could realistically expect from general practice needed to change and criticised newspapers for voicing patients’ concerns over access without also explaining the pressures GPs are facing.

He said: ‘It drives me absolutely mad when I see newspapers criticising GPs for access issues - which are a real problem for patients without accepting the reason why access is poor is their doctors are already working 12 hours a day and struggling. It’s not that they’re twiddling their thumbs and counting the vast amount of money some newspapers claim they are making.’

But he said this narrative could change with GP leaders such as GPC chair Dr Chaand Nagpaul and RCGP chair Dr Maureen Baker fighting GPs’ corner – and said he believed the health secretary, Jeremy Hunt, also understood the problem.

Professor Haslam added: ‘There is a great need for more [secondary care] generalists working in partnership with GPs in the community.’

‘If we can bring these together we will have far more resources in the right place, but at the moment secondary care sucks up so much – and primary care just gets told, “the secret is to get everything out of hospital into primary care”, while simultaneously the budget just doesn’t match it.’

In an earlier session Professor Haslam told delegates NICE recognised the specific challenges GPs face and was fully committed to making guidance more relevant to their daily practice, managing complex patients.

Professor Haslam said: ‘What I know for certain is taking the NICE guidelines for each [single] condition and adding them together is no way to deliver quality care for that person.’

‘It’s absolutely clear we have to find a way of addressing the whole complex issue of multimorbidity and that’s something NICE is absolutely up for.’


Readers' comments (26)

  • Ex-Chairman and President of the RCGP has not forgotten his roots! Preaching to the converted.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Reality bites .
    The cruel intentions of this government is never clearer:
    (1) This fallacy of efficiency saving epitomises its plan to substantially reduce its commitment to fund health service.
    (2) No new money unless one is willing to do all sorts to help these politicians to win more votes in next year general election e.g. £50 millions
    (3) Waves after waves of funding cut with ridiculous workload inflicted misery and desperation in all of us, GPs as well as hospital colleagues . Then the government exploited on our desperation , exhaustion and grief. ' Please leave if you want to, help yourself at the exit door. We can always find cheaper alternative'.
    (4) So if we 'behaved' , the government will give us a salary (do not have high hope about that) and of course, we have to work 7 days. This will happen post apocalypse of the current NHS and a 'new order' is to be restored by the government and all its viceroys.
    (5) As the government will fund much less in health , private medicine will rise , both in GPs and secondary care. After all , many will have stopped believing in national health service of any form by then,(exactly what it wants anyway )
    (6) Yes. The spirit of protesting against this government in any form should be supported.Unfortunately , these politicians are not intimidated by that and probably prepare to 'sacrifice' the votes of most health professionals, apart from those who always want to ingratiate with this hierarchy .
    (7) All I know is one thing: this government only deserves one and only one thing- a full bankruptcy of trust and credibility .
    (8) One thing I keep asking myself everyday - has this government brought out the 'demons' in all of us giving up our original values and virtues?

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    My favourite song in 2013
    Demons by Imagine Dragons

    When the days are cold
    And the cards all fold
    And the saints we see
    Are all made of gold

    When your dreams all fail
    And the ones we hail
    Are the worst of all
    And the blood’s run stale

    I wanna hide the truth
    I wanna shelter you
    But with the beast inside
    There’s nowhere we can hide

    No matter what we breed
    We still are made of greed
    This is my kingdom come
    This is my kingdom come

    When you feel my heat
    Look into my eyes
    It’s where my demons hide
    It’s where my demons hide
    Don’t get too close
    It’s dark inside
    It’s where my demons hide
    It’s where my demons hide

    At the curtain’s call
    It's the last of all
    When the lights fade out
    All the sinners crawl

    So they dug your grave
    And the masquerade
    Will come calling out
    At the mess you made

    Don't wanna let you down
    But I am hell bound
    Though this is all for you
    Don't wanna hide the truth

    No matter what we breed
    We still are made of greed
    This is my kingdom come
    This is my kingdom come

    When you feel my heat
    Look into my eyes
    It’s where my demons hide
    It’s where my demons hide
    Don’t get too close
    It’s dark inside
    It’s where my demons hide
    It’s where my demons hide

    They say it's what you make
    I say it's up to fate
    It's woven in my soul
    I need to let you go

    Your eyes, they shine so bright
    I wanna save that light
    I can't escape this now
    Unless you show me how

    When you feel my heat
    Look into my eyes
    It’s where my demons hide
    It’s where my demons hide
    Don’t get too close
    It’s dark inside
    It’s where my demons hideWhen the days are cold
    And the cards all fold
    And the saints we see
    Are all made of gold

    When your dreams all fail
    And the ones we hail
    Are the worst of all
    And the blood’s run stale

    I wanna hide the truth
    I wanna shelter you
    But with the beast inside
    There’s nowhere we can hide

    No matter what we breed
    We still are made of greed
    This is my kingdom come
    This is my kingdom come

    When you feel my heat
    Look into my eyes
    It’s where my demons hide
    It’s where my demons hide
    Don’t get too close
    It’s dark inside
    It’s where my demons hide
    It’s where my demons hide

    At the curtain’s call
    It's the last of all
    When the lights fade out
    All the sinners crawl

    So they dug your grave
    And the masquerade
    Will come calling out
    At the mess you made

    Don't wanna let you down
    But I am hell bound
    Though this is all for you
    Don't wanna hide the truth

    No matter what we breed
    We still are made of greed
    This is my kingdom come
    This is my kingdom come

    When you feel my heat
    Look into my eyes
    It’s where my demons hide
    It’s where my demons hide
    Don’t get too close
    It’s dark inside
    It’s where my demons hide
    It’s where my demons hide

    They say it's what you make
    I say it's up to fate
    It's woven in my soul
    I need to let you go

    Your eyes, they shine so bright
    I wanna save that light
    I can't escape this now
    Unless you show me how

    When you feel my heat
    Look into my eyes
    It’s where my demons hide
    It’s where my demons hide
    Don’t get too close
    It’s dark inside
    It’s where my demons hide
    It’s where my demons hide

    Unsuitable or offensive? Report this comment

  • The most potent demon to summon is the A+E attendance figures . The government is terrified of it. It haunts their dreams and stalks them through the daylight hours . One month of no out of hours work would unleash it in all its red fanged fury . No OOH and let slip the demon .

    Unsuitable or offensive? Report this comment

  • Then why not become salaried?It will cut down on the paperwork and these days the partners' drawings are not all that significantly above those of salaried docs.

    Unsuitable or offensive? Report this comment

  • Prof Haslam says he believes Jeremy Hunt understands the problems affecting general practice . Of course Jeremy understands - he just doesn't care .

    Unsuitable or offensive? Report this comment

  • Anon 823 -depends what the salary is . Without LES , DES ,QOF then £40k . Is it enough for 8-8 7/7 ?

    Unsuitable or offensive? Report this comment

  • Any system in which supply vs demand is not addressed will collapse. It is only a matter of time.

    Only when the collapse occurs e.g. practices closing, waiting time for GP appointments in months, GPs taking industrial action or walking out will things be addressed.

    Being salaried will make no difference to the underlying imbalance of supply vs demand. It may be better than being a partner in the short term or in certain circumstances but is not a long term solution.

    Demand and unrealistic expectations as has been mentioned many times by posters has to be addressed.

    Unsuitable or offensive? Report this comment

  • Our Responsible Officer is well connected at the BMA and DOH. He warned us at a recent LMC meeting: "keep your registration at all costs, as for the rest I can see nothing". After it has all blown up those of us still on our feet will be able to clean up but in the meantime the DOH / NHS has no medium term plan combined with no commitment:, truly a dangerous mixture. The message is "don't get struck off but the current model of primary care is not guaranteed". I just hope that the blame is clearly placed on the govt and not on us. Well done Maureen Baker for taking the fight to the public arena. Suddenly the subscription is worth it. I'm not so sure about the BMA though!

    Unsuitable or offensive? Report this comment

  • Since Jeremy Hunt had a large part in creating the problems, it is no surprise to hear that he understands them.

    Unsuitable or offensive? Report this comment

  • Anon 8:23am: '...these days the partners' drawings are not all that significantly above those of salaried docs......' It is my understanding that Partners earn considerably more than salaried GP's.

    Unsuitable or offensive? Report this comment

  • Bob Hodges

    " It is my understanding that Partners earn considerably more than salaried GP's."

    I think your understanding might be wrong Neil. There's not much in it in terms of take home, andwhen hours are considered it's often less per hour. I'm ivolved in locality commissioning and LMC so get to looks at this in detail.

    Certainly when I became a partner, the £500 per month increase in taxable pay was more than overshadowed by the increase in hours that I worked as a result.

    Since then, my drawings have reduced and my workload increased further. I'm now earning less than I did as a salaried docotr, and my hours are 25-33% longer.

    Unsuitable or offensive? Report this comment

  • Spencer Nicholson

    all just more reassuring that I escaped when I did sounds like a real s**tfest

    Unsuitable or offensive? Report this comment

  • No, partners do not earn considerably more than salaried per hour and as a consequence we prefer to recruit partners. Your gross drawings at first appear substantially higher but you pay your own employers national insurance and have to ''buy in' which wipes out a lot of the difference. The personal risk legally and financially is much higher, the workload more intensive and the hours are longer. On the plus side partners have slightly more control over their working lives and how the practice runs but many GPs are being squeezed so hard that the current model is at risk of failure with grave consequences to patients. I very much doubt that the private providers will be the shining white nights in armour riding out to rescue the NHS as some politicians and commentators believe.

    Unsuitable or offensive? Report this comment

  • Took Early Retirement

    Strange, innit? Everyone realizes there is a crisis except the SOS for Health. (and the Daily Wail)

    Unsuitable or offensive? Report this comment

  • Dr Mustapha Tahir

    I'm certain Mr Hunt knows the difficulties GPs face daily, but he has a strange way of showing he understands.

    Unsuitable or offensive? Report this comment

  • dear 10.49;
    ''Since then, my drawings have reduced and my workload increased further. I'm now earning less than I did as a salaried doctor, and my hours are 25-33% longer.'' if this is true and the same is true for your partners ....and you still are staying as partners in a GP business...then I am sorry but you deserve the crap thrown by the govt at you. You all need to dissolve the practice and become locum /salaried.

    Unsuitable or offensive? Report this comment

  • If you dissolve the partnership the liabilities are likely to bankrupt the incumbents. You may be down on income but who wants to lose their capital ?

    Unsuitable or offensive? Report this comment

  • Well said, Prof Haslam. Please now say the same thing to the media who are poisoning public perception of GPs. Not a day goes by without me hearing a patient mutter that we are overpaid and only work a few hours per day. After all, if we aren't actually seeing patients, we are twiddling our thumbs/out to lunch/playing golf, as we don't have anything else to do, right? And how dare we have time off for training, holiday, illness, maternity, etc? Until the mass media actually educate the public, this is an 'us against them' battle which we are losing. Public expectation is utterly ridiculous: see their own designated doctor 7 days per week, night and day? Are wee now robots who don't need to eat or sleep, or have a family life? In addition, patients are coming to see GPs every day with utterly minor ailments; coughs, colds, tummy bugs, which a few years ago people seemed to have the common sense to self manage. If a patient expects to be seen as an emergency for every sniffle, then there really is no hope of sustaining GP.

    Unsuitable or offensive? Report this comment

  • You guys need to prioritise your problems and deal with one issue at a time. One concerted campaign at a time. Do you not have a PR agency? When's the last time you ran a nationwide campaign? Oh and please don't give up your practices to corporations- you'll be asked to perform an impossible commercial/professional balance and generally have all the benefits you've worked so hard for eroded.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say