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The crisis in general practice is unprecedented

Dr Kailash Chand

Dr Kailash Chand


It's a big day for general practice - in the press. But for GPs, it's simply a snapshot of the many problems that are enveloped tightly within our profession. 

Which headline are you going to read first? If you work in general practice, you don't need to be picky - we live and breathe the realities behind the words. Day in, day out. No-one's under the illusion that any form of medicine has ever been easy - but today's coverage reiterates just how much the issues are escalating. 

Pulse's exclusive reveals that over half of GPs say they're working beyond safe levels, generally dealing with a third more patients than they believe they should be. The public's safety is, of course, every healthcare practitioner's priority, but this could seriously damage it. 

In a survey of 1,681 UK GPs, the safe limit of patients to see in a day was decided as 30, but in actuality it's more like 41. And one in ten deal with 60 or more patients in a day - which is typically 11 hours long, comprising of eight hours of clinical work and three of admin.

The intensity of workload pressures is similarly high, with 29% deeming their patient contacts 'very complex' and 37% 'fairly complex'.

This may be the first study of its kind, but I doubt GPs will be particularly surprised by the findings. And in a similar vein, the BBC are focusing on figures compiled by the Nuffield Trust that show that the NHS is seeing the first sustained fall in GP numbers for nearly 50 years. Strikingly, the number of GPs per 100,000 people dropped from 64.9 in 2014 to 60 last year.

Numbers haven't declined like this since the late 1960s. Despite a government commitment in 2015 to create 5,000 additional general practitioner posts by 2020, recent figures suggest a further deficit of over 1,000 full-time equivalent GPs. The crisis in general practice is unprecedented, with GPs increasingly leaving the profession due to feeling ’undervalued’. The NHS is haemorrhaging more general practitioners than are entering it.

You probably need no reminder as to why this is - but as this news shines a spotlight on, factors include intensity of workload; administrative burden; lack of recognition of the value of general practice; and the fear of litigation. A combined financial and staffing crisis could cause chaos in primary care for years and ultimately kill off general practice for good. Add to this discriminatory and confusing pension regulation that punishes GPs who take on more work, and it’s a recipe for disaster. GPs are in their role because they want to help people - but in these instances, it's we who need help ourselves. 

Unless GP shortages are substantially reduced, the NHS Long Term Plan can only be a wish list

Across the board, GPs are underpaid and overworked, and this subsequent demoralisation explains why the NHS is losing good people. They haven’t had a pay rise in seven years - even 1% uplift this year - a real-terms pay cut. The entire crop of GPs is undervalued, with consistently more work and expectations placed on them. The overall amount of GP consultations has increased by 15% over the past five years – three times the rate of increase in the number of GPs. The unprecedented pressure on primary care is undermining GPs’ resilience. If morale collapses, it will hammer retention. The workforce crisis consuming primary care could soon eclipse funding as the most serious problem.

We’ve known for several years that the NHS is short of GPs and nurses. Current figures suggest 10,000 extra nurses and almost 3,500 GPs are needed to meet the existing demands. On current trends, this will rise to nearly 30,000 nurses and over 7,000 GPs within five years. Unless GP shortages are substantially reduced, the NHS Long Term Plan can only be a wish list.

In my view, the new GP contract with fresh restructuring of primary care, like Andrew Lansley’s reforms, is not a panacea and will end in tears. Primary Care Networks (PCNs) will mean the end of GP autonomy and the partnership model. PCNs too, like its predecessors, PCTs and CCGs, are set up to fail by taking on too many tasks too quickly without trained staff. Overinflated expectations, as well as time-limited funding and support, would leave general practice in a worse position.

General practice is facing a ‘triple challenge’ of increasing demand, growing workforce shortages and pressure on finances, and I fear it may never recover from this crisis.

Dr Kailash Chand OBE is a retired GP in Tameside

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Readers' comments (30)

  • There has been a war of attrition against partners since 2004 when market conditions dictated a correction in their favour.The mess should have been sorted then.Instead we have been serving a penance partnership has been starved of funding, over regulated, over managed.Going salaried will not solve this the same manager class that bully harass and abuse us now will do that to us as a salaried profession.The youngsters can see this is hospital and in gp land hence the increasing portfolio career.If being salaried is so good Claire look what they have done to junior Drs.Outside London there are massive holes in Hospital rotas due to the damage done to our Junior Dr corps.Claire the relationship between the medical profession and state in the UK is broken the last 15 years have well and truly done that.Your solution suits the Hurley group et al(conflict of interest methinks).Bridges have to be built with the whole of the profession there is a recruitment retention crisis across the whole of the profession at all grades.In general most of us do not trust the establishment(sorry but that includes you as a 'leading GP' at all.I do not know how you(the establishment)are going to fix the damage they have done.I for one can never forgive,and will leave the profession a decade of more before I should have.Ditto most of us I bet.Well done the establishment trying to make a compliant workforce you may well have destroyed it.Who will look after us when we are infirm and end of life!!!!

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  • I think the conversation here sums up the current state of UK practice. There is a huge gulf between the GP leadership/management and grass roots/ coal face GPs. There is a lack of faith that our leaders will achieve anything, and all GPs are seeing on the ground is everything getting worse, despite a string of constant policy announcements, reorganisation, funding tinkering- its all very reminiscent of Neville Chamberlains negotiations. Whether true or not, we perceive too many self-interests at the top and too many cosy relationships. Basically as grass roots GPs 'we aint buying' the message from our 'leading GPs' a term that makes us scoff here at the 'bottom', I hope that doesnt offend anyone. I left the UK as I could see the road ahead. I cannot see a future there. You will not be able to negotiate and meaningful change in terms and conditions with a softly softly approach. The best negotiation methodology in my opinion is to simply say nothing, stop talking, stop training more victims, and for us to quietly pack up, hand over the contracts and slip away. Let the politicians sort out the mess they are responsible for. A meaningful response from the government would be a 'statute of limitations' for the NHS to cut out the ridiculous legal fees, full government indemnity at no cost, and a 10% immediate uplift in the global sum with no strings attached..NONE.........if this pre-requisite wasn't met I wouldn't even bother responding and continue the exodus. The UK needs us more than we need them. I cannot see our RCGP leadership doing any of the above.... We need a Churchill type figure at this moment in time....and I don't see one so I'll stay down here where I am self employed, control my workload, my hours, I can charge as I see fit and I don't have to work with anyone I don't want to, and no I am not a plumber..... I also locum and I don't feel isolated or lost..... my phone has GPS...I'm in Canberra for training this weekend, Melbourne next weekend for another course, and excited about the next couple of years as there are numerous opportunities for keen and motivated doctors around here (None of which involve medical politics- its all clinical)....but sadly none of my UK colleagues with whom I remain in contact feel the same about their futures, they are all just counting down the days or looking for a way out. Given these people are some of the most intelligent and talented people in the UK this is a very sad state of affairs indeed.

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  • NHS partnership crap, NHS salaried crap
    What word links the 2?

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  • Spot on Curious.

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  • whereabouts are you, mr curious? whats life like down there?

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  • Cobblers

    Thank you Curious accurate comments. However "Let the politicians sort out the mess they are responsible for." That's a forever job. There is nothing a politician cannot make infinitely worse.

    On that hopeful thought.....

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  • I used to be married to a dentist Dr Gerada, I know how hard they work, how much they earn and how much regulatory nonsense they suffer. That's why I know GPs would be better-off out of the NHS.

    GP is in a crisis in large part because GP "leaders" like you are committed to saving the NHS at whatever the cost to GPs.

    Of course you would like to see an end to all those pesky Partners obstructing the expansion of the Hurley Group. Partnership is ok for you, but everyone else should be indentured Labour.

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  • This issue could be sorted out overnight if there was a real political understanding of the engulfing problems on the way and a consequent will. There are two solutions- income and autonomy. A 25% pay rise and abolition of the cqc. Stopping usually penny pinching interference from ccgs and blocking incessant gmc meddling.
    Clare Gerarda’s idea of salaried service would be better than the current worst of both worlds but wouldn’t be as good as the long-standing successful role of a well funded truly independent independent contractor status.

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  • And compared to what’s coming 25% is cheap.

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  • Denplan Denplan Denplan repeat after me GPplan GPplan GPplan

    For the price of a monthly mobile sim only plan of $25 think what we could provide

    The ppg was crap, the pag was crap, the pct was crap, the cig was crap the PCN will be crap. It's all bollocks

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