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Partners continuing to take drastic measures to combat workload

Despite a little improvement, GPs are still cutting services, finds Tom de Castella

GP partners across the UK are still having to consider measures such as discontinuing clinical services and handing back their contracts as they struggle with rising demand and staffing problems.

More than one in four of the 424 partners surveyed by Pulse said they have stopped offering certain clinical services, while around one in seven said they had considered closing their practice altogether – up from one in 11 the same time last year.

However, the survey also reveals some improvements in the last 12 months, with fewer GPs temporarily closing or trying to shrink their lists, and smaller numbers considering cutting staff hours or making redundancies (see charts, below.)

But GP leaders said it was worrying that large numbers of partners still had to consider drastic measures.

The workload is twice to three times more than it was

Dr Chandra Kanneganti

Dr Chandra Kanneganti, BMA GPC policy lead for NHS England investment, says that locally in Stoke-on-Trent, a huge number of GPs are looking to close their practice.

‘There are no GPs to recruit. The Government has failed with GP recruitment. I start at 8am and don’t go home till 8pm. The workload is twice to three times more than it was,’ he says.

More GPs have cut clinical services in the past year. One partner said their practice no longer offered freezing and minor operations because they were time-consuming and it was unclear how effective they were.

‘GPs were being used as a cheap alternative to a secondary care service,’ said the GP, who asked not to be named. ‘We focus instead on steroid injections for musculoskeletal problems.’

Dr Moira Langdale-Brown, a partner in Chelmsford, said her practice had stopped providing ear irrigation because it was not commissioned and ‘was taking up a significant number of nursing hours each week’.

Another partner, who asked not to be named, said their practice had stopped IUCD fittings: ‘The funding doesn’t cover the cost of the doctor and nurse time. Releasing capacity was needed.’

The cash envelope to look after patients is ridiculous. It’s like the feeding of the five thousand

Professor Clare Gerada

In addition, Pulse’s survey reveals one in five (21%) partners has cut routine appointments this year – the same proportion as last year.

Professor Clare Gerada, a GP partner in London and former chair of the RCGP, says the number of partners being forced to consider measures including handing their contact back is worrying.

‘The cash envelope to look after patients is ridiculous. It’s like the feeding of the five thousand – GPs are doing a remarkable job given the circumstances but they cannot create miracles.’

The survey findings also reveal the number of GPs considering temporarily closing their lists is decreasing, which reflects figures obtained by Pulse from NHS England in October that showed 106 GP practices closed lists to new patients in 2017/18 compared with 145 the previous year.

But Dr Kanneganti adds that NHS England – which authorises temporary list closures – has become more ‘strict’ in allowing temporary list closures.

Dr Olly O’Toole, a partner in Bedfordshire, confirms this, saying: ‘We are not allowed to close our list.’

However, fewer partners have, or are considering whether to, cut staff hours or make redundancies.

Dr Richard Vautrey, BMA GP committee chair, says partners are increasingly working with other practices to manage demand.

‘Partners still face many challenges.However, many are, through working with other practices or other initiatives, finding ways to manage demand that enable a greater sustainability.’

 

Readers' comments (14)

  • What are thriving practices doing well? There are some around - what's their recipe?
    Is core general practice a loss leader now? It's clear that the value we're adding as GPs isn't widely understood - how do we measure what we're doing and get paid for it?

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  • THE GOVERNMENT IS STILL CONVINCED THAT IF THEY "HOLD ON" LONG ENOUGH THIS WILL ALL BLOW OVER.

    WELL, THEY ARE WRONG.

    IT DOES NOT MATTER HOW MUCH SPIN FROM THE DAILY NUTTER OR GOING ON ABOUT GPs BEING THE "BEDROCK" OF THE NHS THEY DO....THIS IS A MARKET FAILURE AND THEY MUST NOW STEP IN.

    I AM SORRY THAT MAKING GP LIVES BETTER IS SO POLITICALLY UNPALATABLE BUT SOMETIMES IN LIFE YOU HAVE TO DO UNPALATABLE THINGS....

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  • David Banner

    Re ZT- the “thriving practices” are situated in des res areas, best schools, high employment, low demand, CCGs in the black, good value quality contract, often dispensing....but even here applications for partnership are often single figure whilst 10 years ago they were deluged.
    Meanwhile the rest of us in the sink areas are being squeezed by falling income and rising demand, and so a partnership is a poisoned chalice that only a lunatic would accept.

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  • Thank goodness that soon we will be ‘mandated’ to federate, have endlless meetings to share good ideas and general practice will be saved. Maybe I am just to old and cynical but TF will be gone soon, good luck with your inept over prescribing Noctors, God help the patients, general practice is unraveling

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  • I’ve seen no evidence of improvements. I fear, it’s all too little too late. Doesn’t seem to be any plan about GP recruitment/retainment to cover all the OOH and ED GPs they want let alone practice ones.

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  • Agree with my esteemed colleagues above. The truth is that GP as we know it is hanging on by a thread.
    If we are the 'bedrock' where is the recognition and financial reward. There are virtually no new partners to be found - and once the Partnership model folds the entire GP system will collapse as we are the ones not working to rule on a salaried contract.
    They will not appreciate what we have and are doing until we are gone - and by then it will be too late to squeeze he toothpaste back into the tube

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  • Partner in deprived area 24 years. Gave up waiting for things to improve. Am salaried observer with boundaries. Government will realise as the did when they took over the OOH in 2004 that it’s going to cost a fortune when they have control

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  • Would estimate 1000 days to stop GP slipping below the waves for good.Agree with all the above.

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  • Not for me . i work as salaried GP and the partners are piling on the work on me

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  • Well annonymousss the salaried doctors here vote with their feet. They quickly realise that they earn more as a locum with none of the hassle of paperwork and home visits.

    Very few doctors want to become a Partner (I wouldn't); but when you are a Partner it is quite difficult to get out.

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