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The powers that be just don't get general practice

Dr Kailash Chand writes

In last 100 days, this newly elected government has plunged the NHS - general practice in particular - from crisis to deep crisis. Health policy been characterised by a focus on rhetoric at the expense of detail.

Recently The King’s Fund published its assessment of progress since May, and its conclusion was that Jeremy Hunt may be in office, but increasingly it is the Treasury that is in power. Thanks to Osborne, our beloved NHS is expected to finish the financial year £2bn in debt.

Hardly a day now goes by without some ‘bad news’ story about healthcare. The NHS is coming under relentless attack on grounds of ‘quality’ by politicians and the right-wing press, driving the privatisation agenda.  The NHS is on a cliff edge and that underfunding threatens to push it off.

Failure to recruit new GPs is happening at the same time as a third of existing GPs are intending to retire in the next five years. GP practices are rapidly facing a situation where they have neither new or experienced GPs to deliver enough appointments to patients and maintain high quality services.

With medical graduates turning their backs on general practice, there is no sign that the government will be able to fulfil its pledge to recruit 5,000 GPs and open all surgeries seven days a week. The Government’s language on the number of additional GPs that will be recruited and trained has now changed to ‘up to’ 5,000. No plans on how these doctors are being found and paid for have been announced. The idea that paramedics will be asked to act as GPs after 16 weeks of training is deeply disturbing and shows how out of touch the Department of Health and NHS England have become in tackling the general practice crisis. A petition accusing Jeremy Hunt of having ‘alienated the entire NHS family’ with the unrealistic plans has so far attracted more than 201,000 signatures.

General practice is under intense pressure at the moment from a variety of sources to keep surgeries open 8am to 8pm seven days a week. This is overstretching practices in an unsustainable manner. But while GPs are working harder than ever before, they are being hamstrung by declining resources that are undermining their ability to overcome the obstacles they face. Even more worryingly though, GP income streams have declined by 11%  while there has in the same period been a 2.3 percentage point rise in the cost of running a practice (including the amount spent on keeping GP practice buildings in good shape, energy bills for GP practices and the amount spent on GP staff, including practice nurses and receptionists).  The cost of running a practice now accounts for 61.6% of GP budgets – a huge amount.

I challenge any government to find a model anywhere in the world that can match the range, remit and responsibility that we take on and provide as NHS GPs.

General practice is the most cost-effective and efficient arm of the health service – GPs keep the rest of the NHS stable and secure. Once general practice starts to crumble, the entire NHS will follow, with disastrous consequences for our patients. Instead of taking urgent action to address the real issues facing general practice, the government has focused instead on attacking GPs’ professionalism and announcing a four-year pay freeze, thereby demoralising the very staff on whom patients rely.

There is a clear solution: we need to have long-term, sustained investment across a range of GP services. Practices need to be backed with proper resources, better premises and an expanded workforce. The pipe dreams must stop: it is unfair on GPs and patients to raise expectations that can’t be delivered. Nobody disputes that patients should have access to the same quality of care, seven days a week.

If Hunt is genuine in his commitment, he should be working with the BMA and other unions to achieve a common goal, rather than labelling the BMA a road-block to his reforms. A divisive approach is not in his interests, nor does it serve the public.

Who can disagree with Mark Porter, chair of the BMA Council, when he said: ‘When it comes to the NHS, to describe the Government’s performance over its first 100 days as a disappointment would be a gross understatement.’

This drastic contrast between reality and what is being promised politically is dragging down GP morale. It reinforces the view that the powers that be just don’t get it. An administration, that promised to empower GPs has proved an abject failure on its own terms. GP morale is at its lowest ever level, many are retiring early from the profession in despair, and services are in crisis.

Dr Kailash Chand OBE is the deputy chair of the BMA, and a retired GP

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Readers' comments (24)

  • I take issue with your title. It should be "the BMA just doesn't get General Practice".
    Your entire article demonstrates that your fundamental beliefs are faulty. You think the Govt can be persuaded to stop the ramping up of demand and can be persuaded to find shed loads of money to simply throw at GPs. If you could just present them with the right discussion paper they will see how wrong they have been and what they need to do to put it right.


    Nothing will persuade the Govt to do that because it is fundamentally not what they want as an outcome. The Govt wants rid of publically funded, small general practice owned by small groups of partners. It wants GPs to either go private or sell out to just two or three huge corporations that it can deal with directly.
    Your attitude, may I say, smacks of head in the sand and is typical of the BMA and GPC. You think your (the BMA/GPC) raison d'etre is to defend the publicly funded NHS at all costs. The members who pay your wages thought your raison d'etre was to look after doctors. The BMA/GPC's absolute refusal to come up with plans for how GPs can go private, can resign en masse etc, shows that you are willing to let general practice be killed as long as you can stand aside bleating about how it should be publicly funded and needs more money simply in order to salve your own consciences. The BMA/GPC are betraying doctors for the sake of your personal political ideologies.

    If you really want to help doctors stop banging your heads against a government brick wall that will never listen and start publishing the exit plans. If you won't, please stop pretending that you represent GPs, because in my opinion, you don't.

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  • Hear hear

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  • Good quality general practice is clinically effective and clinically effective. It includes continuity of care. It is the key to any health care system, not just the NHS. It is being cynically eroded , and the effect on the public will felt for decades to come , irrespective of whether the NHS is the health system in the UK, or whether it is replaced by a private, insurance based scheme.

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  • Anonymous | Practice Manager | 18 August 2015 8:53am

    SPOT on.

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  • Looks like the PM has called it right. We are all under the illusion that the government wants to solve our problems. We are Through The Looking Glass here people. Our problems are the product of policy. This is intentional. We are to be exterminated, chopped up and sold off. First step is to squash our morale so low we all retire/quit/ emigrate. Then, when only the desperate are left, comes the Solutions phase. We will not like it. That our representatives have stood by, watched, and in many cases applauded, is a scandal for the ages. But the cavalry, emphatically, are not coming. Please turn off the light as you leave.

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  • I am sorry Dr Chand but the comments above demonstratea better understanding of Realpolitik than you do. Your assessment of the problems facing GP are accurate but just stating them is not going to make a blind bit of difference. This government is intent on destroying the NHS and if you can't develop some hard nosed strategies than your deputy chairmanship of the BMA is just collusion.

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  • 8.53 is right. Why do we want to remain slaves to governments we all hate so much? If we go private the patients will turn their ire on government for their nhs subsidy and would realise how little nhs pays for primary care.

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  • "Parents Just Don't Understand"

    DJ Jazzy Jeff & The Fresh Prince

    You know parents are the same no matter time nor place
    They don't understand that us kids are gonna make some mistakes
    So to you, all the kids all across the land
    There's no need to argue, parents just don't understand

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  • How ironic, the BMA don't get grassroots GPs, and seem to not get the govt's agenda, or chooses to go along with it.

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  • @ 8:53

    100 % Completely agree with you! So do many others. BMA/GPC through being so impotent and ignorant are ruining so many careers and the livelihoods of so many families. Shame on you.

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