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At the heart of general practice since 1960

Can GPs really be both scapegoats and saviours?

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The Government has a nasty habit of painting GPs as either heroes or villains to suit ministers’ needs.

Earlier this year practices were blamed by the Prime Minister for increasing pressure on A&E by closing in core hours. Newspapers accused the profession of ‘clockwatching’, demanding GPs open up ‘when patients want’.

A measure to punish errant GPs who brazenly use lunch breaks to grab a sandwich on the way to some mandatory training or a home visit was included in the new GP contract. ‘Open or lose cash’, is the threat.

We are not even close to stabilising general practice

Now, seemingly with a straight face, the Government is portraying GPs as the solution, asking them to staff a new ‘front door streaming’ service at all A&E departments by the end of the year. This, ministers’ logic goes, will enable emergency departments to focus on urgent cases – completely glossing over the fact they’ve just ordered GPs to stay in their practices and open longer during the day.

There’s more. Just last month, ministers told NHS England to start work on ensuring same-day GP appointments for all over-75s (as promised in the Conservatives’ election manifesto in 2015). Add the pressure to continue rolling out David Cameron’s seven-day access wheeze and you start to wonder whether ministers are ‘gaslighting’ the profession.

The truth is that some of the Government’s ideas are good. The evidence is mixed, but you could see a GP triager would be ideal to sort the life-threatening from the trivial at A&E front doors. Similarly, I know no GPs who would not like to offer frail elderly patients better access, or who would balk at running the odd evening surgery for commuters.

But the problem is we are operating at a time when numbers of GPs are actually falling. Ministers like to trumpet the fact we have record numbers of trainees studying general practice, but even if you include these, overall numbers are down. We are nowhere near the mythical 5,000 extra GPs promised by 2020, not least because so many GPs are cutting their hours or leaving altogether.

Even the chief executive of NHS England – a man I am repeatedly told ‘gets’ the workload avalanche crushing GPs around the country – told a parliamentary hearing that managers will be collecting data on GP waiting times this year with the ‘reasonable expectation’ that access should improve as money from the GP Forward View materialises.

But as we show today, one year on we are not even close to stabilising general practice; closures continue at record levels and some towns are uncomfortably close to having no practices able to take new patients at all.

Even simple measures, such as telling hospitals to do their own work, are not being policed. The money from the GP Forward View will barely keep the profession pedalling, never mind attempting the Tour de Extended Access.

All the time, ministers are playing to the gallery, boosting patient expectations, desperately trying to show they have a grip on the situation and are able to spray GPs all over the country at will to solve the NHS’s problems.

They don’t and they can’t. And they need to stop pretending otherwise.

Nigel Praities is editor of Pulse

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Readers' comments (7)

  • Dear Nigel,
    Could you please offer this excellent editorial to one or more national newspapers, to publish?
    Thank you.

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  • Supreme blog - excellent summary of current situation.

    Please share this with the national media.

    Thanks for understanding Nigel, when no-one else does.

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  • Excellent article. Go with the above. This needs to be published in a national paper and picked up upon.

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  • Vinci Ho

    Chinese saying :
    Want a horse to be 'good' , but also want the horse not to eat any grass.....

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  • A safe system would have a hospital follow up after a complex admission as default, not hope the f2 dr of the day gets all the actions into a hastily written discharge summary that dumps responsibility to the GP for things the patient has no idea about.

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  • My A+ E department had 2.5 consultants 15 years ago when I worked there. They now have 13. My practice had 3 doctors at that time, we still have 3. The system is not balanced. Let one of these 13 guys sit at the front. , that is what they are trained for.

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  • But this is what a GP colleague IS saying in the national press: https://www.theguardian.com/commentisfree/2017/apr/10/celebrate-nhs-gp-surgeries-closures-apocalyptic-picture-unfair
    ...which is frankly very unhelpful.

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