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Gold, incentives and meh

General practice has no place for gimmicks

Dr Kailash Chand

In the run-up to the 2015 general election, then health secretary Jeremy Hunt promised an extra 5,000 full-time equivalent (FTE) GPs by 2020/21 - a promise that did not materialise.

Now, another empty promise of extra 6,000 GPs. Have they found a magic tree that grows GPs?

The reality is that we have a sustained fall in the number of GPs relative to the size of the population across the UK.

As population has been growing, we've lost 1,000 FTE GPs since 2015, so we're 6,000 down on Jeremy Hunt's pledge. 

It’s clear that, in cash terms, primary care remains in ‘intensive care’ and all political claims to boost funding are election mirages.

Since 2010, there’s been a 30% increase in consultant numbers, but the amount of GPs has fallen.

The Health Foundation and the King’s Fund have suggested that the shortfall in GPs could grow by around 4,500 full-time equivalents in five years, unless urgent action is taken.

This shortfall reflects a pattern of falling recruitment to GP specialist training, and increasing proportions of GPs leaving to work abroad, take career breaks, work part-time or retire early. Such deterioration is serious enough to render the ten year plan and five year forward view impossible.

Denials from the Government and NHS England don’t fool GPs

Denials from the Government and NHS England don’t fool the GPs currently in post.

Hospitals’ financial problems always make headlines, and someone usually picks up the bill.

But general practice doesn’t have that luxury, and its share of the NHS budget has fallen progressively in the past decade, from a high of 11% in 2006 to under 8.5% now.

What’s more is that BMA analysis shows that more than 600 GP practices in England will be lost in the next four years if investment doesn’t increase - and current funding for general practice falls £3.7 billion short of the BMA’s target of 11% of the NHS budget.

Although additional funding for the NHS has been committed, the amount going to general practice in real terms hasn’t increased

My 35 years of working as a GP at a small practice taught me that patients value continuity of care, with doctors and nurses who they know and who know them.

After all, continuity of care has been part of the general practice philosophy since its inception.

There’s a plethora of research that shows the value of continuity of care in reducing ill health and saving lives, and enabling cost-effective health systems to function.

In all the reforms of the last two decades, continuity of care been the most worrying casualty.

There’s no doubt that our political masters will carry on with their madness of dogma-based changes in primary care in the near future, but we must ensure that it supports and incentivises continuity of care in its policy development, care models, payment method, training, data analytics, community consultation and overall messaging.

That’s the only way to restore the ‘jewel in crown’ title of general practice to motivate current GPs to keep working and encourage the recruitment of doctors towards our profession. 

General practice has been the foundation of the NHS for the last 71 years. To guarantee its future for the next 71 and beyond, political parties must unite and take urgent action, rather than churning out more gimmicks

Dr Kailash Chand OBE is a retired GP in Tameside

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Readers' comments (4)

  • I perceive an undertone of suspicion towards PCNs if they plough head first into dismantling smaller practices and forcing mergers. Continuity of care will be lost, and policy makers fail to recognise quite the damage that could do to patient outcomes and staff morale (to name a few). A top down reorganisation of services could prove a nail in the coffin to primary care. We need fewer ‘yes men’ representing us in leadership roles, and more honest debate. And, for God’s sake, why not test a few PCNs over a number of years. Some impartial evidence for patient or staff benefit wouldn’t go amiss. This is a gimmick and could be a deeply damaging one which takes decades to come back from.

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  • GMC should actively promote their "Duty of Candour" to the politicians and the royalty.

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  • Hmmm, you might have missed a trick there Kailash.... The birthrate for white Caucasian Brits is 1.6 (Office of National Statistics 2018) i.e below replacement rate, yet the population is increasing.... I wonder why???

    Your entire article is a rant against how the govt is screwing healthcare (and indeed the country) over. Yet your solution? To beg essentially the next govt to 'take urgent action'. I think you can do better than that, how about wisening up, letting go of partisan idealogy and admitting the truth - the govt involvement in healthcare, and indeed other policies, is the problem in the first place. And the solution is clearly to limit this to the bare minimum

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  • too late to go back to the halcyon days of personal lists of around 1800. The future is to get rid of the primary/secondary care divide and for all newly qualified doctores to work for at least 5 years as generalists and then all to specialise in 2 areas -current GPs like myself are essentially geriatricians and psychiatrists. Higher trained practice nurses will be the fist point of call, the new GPs.

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