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Gold, incentives and meh

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)

  • The most drastic and maybe sensible measure is to jump ship! Maybe then a more realistic system could be achieved. Easier said than done however as the water we jump into is probably full of sharks (aka NHS managers who would sue us for breach of contract)!

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  • All unfunded work is being cut. We've also stooped out EH clinics. Lots of idiot admindroids even in our own CCG come up with unfunded work they assume 'must be done'. Work to rule is here in many places already. It makes GPC work even more important. But we've noticed NHS does not always respect commitments they made there (eg. violent patient scheme).

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  • The thriving practices are run by younger hungry fresh new GPs often in committed pairs/relatives.In areas where enhanced services pays so well that killing yourself for it is more than worth the financial reward. Of course the enhanced services i those areas expected that you would employ more staff to do the work ad help improve local practice population health overall. But there are certain types of Gp's that would work very hard indeed if the financial reward was worth it. In fact some of the highest paid enhanced services are in the most deprived areas as they need to attract and retain staff.

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  • I see partners fill most of their appointments with ‘meetings’ and easy follow ups ( I would do the same) to save their sanity. Younger GPs are already jumping ship as they feel the water going past their knees. We don’t need more GPs, we need a new ship.

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