Just maybe general practice should get money for nothing
Our February issue's two big articles sum up where general practice is at the moment. Our cover feature shows the probable fate of the health secretary’s efforts to increase the number of GPs, with the exodus of mid-career GPs unlikely to be offset by younger doctors or overseas recruits.
Meanwhile our analysis of the primary care network DES specifications confirms that any extra funding stumped up by the Government always has significant strings attached.
I’d love a senior official to sit health ministers down and spell out the obvious: that the only way through the general practice crisis is to give practices no-strings funding to spend as they see fit.
Basic supply and demand economics dictate that the funding on offer is not enough for what GPs are expected to do: if it were, we wouldn’t be set to lose almost 2,000 GPs by 2024, as our analysis predicts.
But I’d suggest that – in the equation of available funding vs what GPs must do to get it – the funding is not the major problem. The cash on offer now is more than at any time over the previous decade of stagnation. True, it is still not enough, but at least it’s something for GPs to work with.
No, the problem is what GPs are expected to do for it. Because Government policy seems to incorporate two ills: first, no funding without more workload, such as fortnightly care home visits by GPs (unless you can find a community geriatrician ha ha); second, you can have the money, but we decide how you spend it – ie, within a network and a significant portion on precisely defined new staff. And have a look at Matt Hancock's recent comments for proof.
GPs are ‘best placed’ to decide where funding should be spent
It feels as though GPs aren’t trusted to use their professional judgement on how to spend the money. But this needs to change, because one area where GPs really are ‘best placed’ is in deciding how to alleviate their own workload and therefore keep GPs in the profession.
GPs know how to use their funding – they’ve been doing so successfully for the past 70 years. With the necessary funding over a sustained period, GPs could turn around the crisis. They are in the best position to incentivise leavers to stay within the profession, they are the best people to choose their own staffing skill mix, and they know the best configurations of practices for GPs and patients.
They are also best placed to decide whether the funding on offer is fair for what they are expected to do. And our latest Pulse survey reveals 80% of GP partners in England are willing for their practice to give up Network DES funding – which incorporated the majority of last year’s funding uplift – rather than shoulder the extra workload it would bring.
I get that money for nothing for ‘high earning’ GPs would risk the tabloids’ wrath. But if the Government is worried about this, it should consider what patients want. And I can pretty much guarantee it is not enhanced care home visits, medication reviews, personalised care plans, etc. What they want is not to wait three weeks to see their GP – something Boris Johnson acknowledged in his very first speech as PM.
With no-strings funding, GPs could achieve this. Without it, ministers can’t hope to recruit and retain new GPs – you don’t get chicks (or guys) for free.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at firstname.lastname@example.org