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Independents' Day

How can a ‘primary care workforce review’ say so little about GPs?

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I would expect nothing less from Professor Martin Roland, but his Primary Care Workforce Commission report contains a lot of good sense.

It is refreshingly straightforward to read, with little of the meaningless management speak that usually poisons the waters of NHS reports. It speaks compellingly about the need to free up GPs to conduct longer consultations with patients and the vital importance of ensuring continuity of care, particularly for children, the elderly and in mental health.

Common-sense ideas, such as GPs being given time to communicate directly with consultants by email or instant messaging, are peppered throughout the report. But the striking thing about the report is how little it says about GP numbers.

Announcing the review at the RCGP conference in October last year, the health secretary said it would be an independent study of exactly how many GPs we need ‘area by area’. ‘We need to know exactly where we are underdoctored and by how much,’ he said.

But this is not what has been produced. It mentions the GP shortage and notes the Government’s commitment to an additional 5,000 GPs by 2020 and has some intelligent things to say about the lack of GPs in deprived areas.

But the whole report is rather more concerned with extolling the virtues of a ‘multidisciplinary primary care workforce’ – the physician associates, practice pharmacists and medical assistants that we have heard so much about recently.

Professor Roland is quite right that these other clinical and support staff can make a significant difference in GP workload. Paramedics carrying out home visits, physician associates dealing with acute minor illnesses and medical assistants tackling the paperwork that GPs have to do could make the job more manageable and less of a gonad-bustingly exhausting daily grind.

But – as the report mentions – these staff cannot work alone and more GPs are needed to oversee the care they provide.

I suspect his paymasters would not have thanked him for it, but I would have liked to see a whole-hearted endorsement of the role of GPs and some imaginative ideas on how to retain and attract them (and perhaps a dire warning that if the job is not made more attractive then you might as well forget the 5,000 GP target - although the Jeremy Hunt is trying to).

Some have criticised me for pointing this out in a previous blog, but I make no apology for saying it again. These new clinical and support staff are no replacement for more GPs, and we end up in a dangerous place if this is not also made top priority.

Nigel Praities is editor of Pulse

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Readers' comments (11)

  • Your previous article was on the money - I have no idea where the sudden spate of frothing apologists arrived from - almost all GPs would agree with you, and, frankly, this is the sort of common sense we would hope for from an magazine for General Practitioners.

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  • 'physician associates dealing with acute minor illnesses'

    It is vital this isn't the main message regarding physician associates and it leads to the backlash.

    Minor illness is a retrospective diagnosis.

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  • Excellent summary of the issues Nigel.

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  • Vinci Ho

    You see , Nigel, you got stabbed very quickly and maliciously when people disagreed . Look at what happened to Jon Snow at the end of last season of GOT. Sorry I called you that name , need to find another replacement now.

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  • There is no incentive for DoH to increase GP workforce. Most govt departments are having to make cuts & despite NHS funding being increased there is still a significant deficit predicted over next 5years. From the eyes of Govt GPs are expensive (overpaid?) and independent contractors which are both factors that they find irksome.

    I would therefore suggest then that a reduction in GP numbers is what is planned and consequently what we are faced with having to deal with. If this is the case we have to think of other ways of working in order to remain viable (including a radically different workforce in terms of skill mix) or we leave the NHS.

    This is the context that we as a profession are having to face. We may have reservations about transforming the primary care workforce without increasing GPs but I suspect that this is the corner that we are being backed into.

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  • The only way to understand why the Government acts as it does, is to think in financial terms.

    Practically all NHS workers are a drain on Government finances. If we deliver good outcomes people live longer. This adds more to the cost for the Treasury and brings UK PLC further into debt. The only aspect of our healthcare delivery that can improve GDP is if we keep people working to raise GDP... a very sobering thought. From a financial perspective those who do not bring in GDP are a drain on Government finances. By the way we have a right-wing government... Coincidence?....

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  • The fault really and compelling lies with us doctors and our Union, the BMA, for never defining safety at work [ in hours worked, patients seen by speciality] and a reasonable and fair [ to all parties ] work life balance.
    So I did over 700 hundred 80 hour weekends with very little sleep. This is considered the norm, till the EU defined safety for juniors. Had it been up to the BMA, juniors would still be working those insane hours.
    So and similarly, it is time the rest defined safety too. I think even Hunt would concede that no one [ not even doctors] can work 24 hours a day 7 days a week, 365 days a year.
    Well then how many ?

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  • You should have understood by now that anyone can do a GPs job and much more cheaply.

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  • Because health care in this country is run by amateurs.

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  • We are part of a team, yes we might like to think we are the captains but we need team mates to work with if we are to reach our goal and save the NHS.

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