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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)

  • Cobblers

    $25? 7:42.

    Make that Pounds maybe, but Guineas would be better. :-)

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  • Dear QB
    I am mostly in Tasmania but about to head up to WA for some rural and remote medicine. Tasmania is gorgeous... main barriers for new Drs coming down is the DWS restriction and a glut of their own medical students down here so you would need to move on this quickly . The advice I would give would depend on your own family circumstances. You ned to be wary of some unscrupulous clinic owners, stay away from the big cities which are over doctored. I would always do a short contract first to test the waters and dont move your family over until you are happy. Working salaried for a health board is a safe bet so you're sure of income and you can get accommodation provided - but these jobs entail a degree for ED work . If you are willing to go remote and work some antisocial hours then I am aware of GPs making in excess of $700k AUD / £375k GBP (£250k a year AFTER tax)but these will be in hot and dusty locations... and not great for a young family. Next week i will earn £6000 for a 6 day week..... but I finish at 3:00pm every day....indemnity is a lot cheaper down here, but you'll need the savings to pay for your medical insurance. Canada is also worth a look. If you are later on in your career New Zealand is fabulous, but pay not as good....

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  • Needless to say for me working salaried for Hurley Group is not an attractive offer..... I am my own boss here..... and love working alongside other 'own bosses' - and most people work collaboratively rather than subserviently, yes there are those who want you to work 'for them' rather than with them, but those are the types to avoid. I've found out about a few more interesting courses.... check out 'unconventional conventions' for your CPD! There is an enthusiasm for the job down here, more so in the rural areas. I've now a long list of places to go and work, Norfolk Island, King Island, Lord Howe...... you get paid to visit and work in some of the most beautiful, remote and ecologically interesting places in the world...... I can't think of any GP here who would go back to the UK unless forced to by family circumstances..... the schemes to attract GPs back are a complete waste of time....

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  • Apologies QB Im supposed to be one of those negative doomsayers / conspiracy theorists etc in the eyes of the RCGP so I didn't mean to let my enthusiasm slip out there...... I nearly made it sound like you can enjoy being a GP again....... I'll stick to more negative comments in future :-)

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  • If, knowing my state of health, you heard I was entered to run a marathon you would think I was mad. If you heard I was doing an unlimited and increasing amount of work for patients for a fixed payment you would think the same

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  • but there is one thing I want to save about the NHS: the lack of a link between what treatment or investigations etc I advise for my patient, and my remuneration. Can you get that in a private or insurance-based scheme?

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  • Clare Gerada is London centric like most of our “leaders” and has no idea what life is like beyond the boundaries of the Emerald City ( as do most of our useless politicians).
    She talks to doctors.....
    We’ll try talking to doctors in Plymouth or Blackpool for example where their professional life is unbelievably tough, yet they keep going in order to look after their patients despite no promises of gongs or garlands or airtime.
    Try listening Clare....

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  • 'Just retired' where in the country are you? Do your colleagues maintain their RCGP membership? Be interesting to know what the true figures are. Whats the picture in General practice like where you are? It would be interesting to hear the thoughts of your colleagues too......Jaimie (Ed) can you do a map of the UK and get GPs to put feedback, both good and bad as to whats happening in their locality? It would be good if we could get a more representative picture from all the readers so we can all see more clearly the state of general practice across the country to look for regional variations..... is there a London/ everywhere-else divide? What are RCGP membership levels like? There must be plenty of GPs who still keep it on as well as plenty of those who have ditched it.... are there age/gender /geographical factors between members and non members? Id love to know more.....

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  • I got the MRCGP in 1997 (7 years after taking a partnership) so that I could take my turn being a trainer. I paid the compulsory first year's subscription, and after reading a couple of the journals I ditched my membership.

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  • RCGP membership rising, unbelievably. Perhaps people daft enough to fund these parasites deserve to be dumped on.

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