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Independents' Day

How Hunt’s admission of failure on GP numbers could harm practices

Pulse editor Jaimie Kaffash examines the implications of the health secretary’s admission that he is likely to miss his GP recruitment target

Health secretary Jeremy Hunt’s admission that it would be a ‘struggle’ to recruit 5,000 new GPs may not be a surprise, but it could have significant ramifications for practices.

He didn’t go as far as to ditch the pledge – explicitly saying that he was still working towards it – but his interview with the Guardian is at the very least a back down.

The announcement shows Mr Hunt is facing up to reality: as Pulse has reported, we’ve lost more than 1,000 full-time equivalent GPs since he made the pledge in September 2015, meaning he needs to boost numbers by more than 6,000 in two years.

Now, he is making the first steps towards distancing himself from the target.

‘We do need 5,000 more GPs and we are struggling to deliver that pledge, but I’m absolutely determined to do so because GPs are working incredibly hard; too hard,’ he told the Guardian.

‘I got quite widely ridiculed when I made the pledge in 2015. I wanted to nail my colours to the mast of getting more GPs into the system. But it has been harder than we thought.

‘This is not a pledge that we’re abandoning because it’s a very, very important pledge for the NHS and with general practice. It’s just taking a bit longer than I had hoped.’

In other words: we’re not abandoning the pledge, but don’t expect us to fulfil it.

It has been harder than we thought

Jeremy Hunt

This is not good news for GPs. While the target was still live, we saw NHS England going all out to try and fulfil it. The move to recruit up to 3,000 overseas GPs was desperate, but that doesn’t mean it wasn’t helpful.

Yet there is little sign that they will be successful in this. At last count, there were only 85 overseas GPs working in practices, and these were only in the pilot areas – which were already being successfully led by GPs. NHS England promise there will be more by September, but this relies on overseas GPs actually wanting to come to England.

Other measures to increase numbers are well-intentioned, but are doing very little to the overall numbers. NHS England is ploughing £10m more into the retainer scheme to keep GPs in the profession. There are also more graduates than ever entering GP training.

But these are only small victories. The retainer scheme persuaded 250 GPs to stay in the profession last year – which is great, but will hardly save the profession. And we still don’t know how many of the record trainee numbers stay in the profession – incredibly, there is no widescale collection of data into this.

Following Hunt’s announcement, the political pressure to escalate these measures – however limited – might be taken off.

What we may see, in that case, is a focus on an area where NHS England has been much more successful: recruiting non-GP staff.

The GP Forward View sets a target of 10,000 new primary care staff: 5,000 new GPs and 5,000 non-GP clinical staff. As NHS England are keen to point out, they have almost hit their target on the wider workforce. There’s been an increase of 4,484 non-GP health professionals working in general practice from September 2015, against a target of 5,000 by September 2020. This fits into the agenda to work in larger practices, with the GP working within multi-disciplinary teams – and it will surely be only a matter of time before the Government and health managers increase the number they are targeting.

The process to secure funding for pharmacists is often laborious

BMA review of the GP Forward View

In some ways, these non-GP health professionals can be a great help. The 1,100 clinical pharmacists recruited, for example, are helping practices. Indeed, in Northern Ireland, the BMA says that they are ‘seen as an important first step in securing the future of high-quality GP-led services’. There are problems with recruiting clinical pharmacists – the BMA says ‘the process to secure funding is often laborious’ – but when recruited, they are an asset.

The same is true for mental health professionals. An increase in these numbers is of great help to practices. Yet there are problems with NHS England’s pledge for 3,000 additional therapists working in primary care. The BMA points out that these therapists are employed by IAPT services, not by practices, only some of these new practitioners will work in practices. Its survey of LMCs found that few practices report genuine access to these new therapists.

But there are other healthcare staff that are a bit more controversial – and these are the professionals that the Government will find more easily. For example, the Government is supporting universities to educate more physician associates. The target at the moment is 1,000 to work in general practice, but with lower training costs, this might be a cheaper alternative to GPs in the future. Unlike pharmacists and mental health therapists – who bring unique skills to the practice – a physician associate will be taking on GPs’ roles, just with less training and education.

We are still waiting for NHS England and the Government’s response to Mr Hunt’s admission. Neither have had anything to add to these comments. But they are a watershed. And it won’t be a surprise to see the rhetoric change in coming months to emphasise the 10,000 new practice staff figure – the vast majority of whom will be taking on GPs’ work without GPs’ skills.

Readers' comments (13)

  • I wouldn’t be surprised if GPs get blamed for not achieving the 5000 target. Somehow it will be our fault for leaving the profession or not committing.

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  • So, post BREXIT, foreign trained GPs are not clamouring to come and work in the NHS ?

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  • Jeremy Pudendas pledge was to get 5000 more GPs by 2020; he now tells us it is going to take longer but the pledge still stands. If he were to consider his words carefully then his pledge is invalidated-unless he means the 5000 GPs will be in the system before the end of 2020 instead of earlier in that year. He takes the pi~s out of a dumbed-down public who seem to have forgotten another pledge (cut immigration to the tens of thousands) which the government clings to with no realistic prospect of delivering it. I think I should just shut-up and get back to Facebook.

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  • AlanAlmond

    I guess we just have to get used to the idea that the future of U.K. primary care doesn’t involve many Drs. There comes a point when acceptance is the only sensible option. Trying to move on but obviously not quite there yet, as here I am, reading pulse and posting. One day soon I’ll have shake the Dr delusion, be gone and you’ll be spared my woeful comment. Just a little too angry and stubborn to go just yet.

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  • I have worked as a GP at a struggling practice. We found it difficult to recruit non GP health care professionals with the right skills at the right price who were prepared to do all the work required. Large gaps in care were left as we ran out of money, compared the previous situation where GP partners got on and did extra work as needed. You have a problem Houston.

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  • It is no surprise that it is proving very difficult to recruit overseas GPs. The NHSE and the govt is being forced to swallow the bitter pill. The fact is the GP work in the UK is so toxic with a very high regulatory burden, GMC, CQC, constantly changing work, years of restructuring and ever changing goalposts, dwindling practices income, increasing workload, dumping of work from hospitals, rising expectations that GPs will also be social care champions and not to forget a very high public expectations.
    Faced with these challenges who would be happily lining up to come and work in the UK general practice.

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  • The UK GPs are leaving the country. Any overseas GP that come will soon learn why and leave for the better weather, pay and working conditions abroad. The climate to practice now is terrible and one faces Jail from Gross Negligence Manslaughter due to system strain and failures. Just imagine in Dr Bawa Garba's case if anyone of us rather than the mum gives the Enalapril. It will be highlighted to no end and we would be sent straight into jail.

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  • A system has to be fundamentally fair- otherwise it will cause harm. You have a society/politicians that expects more from its health service and yet wants to pay less for it. You have a system that criminalizes doctors for doing their job and yet expects them to be open when they make mistakes. You have have a minister that promises to recruit more doctors but won’t address why doctors are leaving.

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  • Too many people on a cramped tiny island

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  • Dear All,
    So if Mr HUnt reckoned we need X doctors to do the work, and he can't supply x doctors, which bit of the job do we stop doing?
    Paul C

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