Act now on GP recruitment to protect patients
The NHS cannot afford not to have a strong primary care workforce, says Dr Tim Morton
The British public are bombarded with media images of doctors saving lives - especially on TV. One only has to flick through the channels to find Helicopter Heroes and 24 Hours in A&E among many I could mention.
It is not only the public who have a distorted view of everyday life in the NHS. It is a sobering illustration of the looming workforce crisis that the medical students who are taught in our practice rarely aspire to a future in primary care.
In recent weeks, we have witnessed the media storm over 111 and A&E departments being overwhelmed with queues of ambulances waiting outside. The journalistic slant has been that it is all the fault of GPs that patients end up seeking help in inappropriate ways.
But general practice is also at saturation level and GPs are just as stressed as our colleagues in A&E and ambulance services. I look around the practices in my area and see GPs putting in 11 hour days without lunch breaks, too shattered to contemplate an out of hours shift - especially in addition to an extended hours surgery which satisfies the political knee-jerk response of a previous administration rather than a true clinical need.
Demand exceeds supply
It has long been recognised that UK primary care is well regarded worldwide and is extremely cost-effective for what it achieves.
The harsh reality is that with ageing demographics, demand exceeds supply - or rather, patient/political wants exceed clinical needs and the impending workforce crisis staring us in the face will make the fiasco of 111 implementation, overwhelmed A&E departments and the appalling situation outlined in the Francis report seem like storms in NHS teacups.
Why am I so pessimistic and worried? I should be reassured by Government pronouncements that more doctors are being trained and employed. But according to the GP National Recruitment Office, 916 fewer trainees were recruited to ST1 posts than anticipated in 2009-11. GPs over 55 are seriously considering taking their pensions early, yet this group includes the vast majority of the cadre of senior GP tutors currently teaching the next generation.
Who will enthuse, inspire and teach this new generation of GPs? GP tutors certainly don’t do it for the money and in these harsh economic times when practice business plans require more boxes to be ticked and income to be protected, it is easy to view training as a luxury and many practices may decide they can’t sustain it.
A survey of our three local vocational training schemes produced not unsurprising results. Only 52% of trainees said they intended to look for full-time work and only 10% said they felt ready or even wished to seek a partnership. This may reflect the changing demographics of medical students who are joining general practice later in their lives than previously seen and, because of this, often have pre-existing commitments which limit their availability and dictate a certain work-life balance.
This is supported by data from the NHS Health and Social Care Information Centre which shows the number of consultants rose by 49% over the past 10 years while the number of GP partners fell by 4% over the same period. Interestingly, the number of salaried GPs - a group largely made up of those working part-time - rose by 720%.
Time to rally round
The NHS cannot afford not to have a strong primary care workforce. We are professional risk managers who - in order that the wheels of the NHS keep turning - are constantly assessing the odds of patient symptomology.
If the government wishes to use NHS pathways - as so well demonstrated by the 111 service - it will soon come to the same conclusion as many experienced GPs; that there are just too few bums on the proverbial seats to make it happen. This wouldn’t matter so much if patient safety wasn’t at being put at risk. Too few GPs leads to patients finding the path of least resistance and ending up at the door of A&E with the taxi service provided by the ambulance trust.
We need to change perceptions about primary care from the start of medical training. When did you see a GP heavily featured in a medical school prospectus rather than the glamour docs of cardiothoracic surgery?
The Government and local education and training boards need to increase funding of primary care postgraduate training to make it viable. They need to reduce some of the hurdles to becoming a GP trainer and become less hospital-centred in their workforce planning. Clinical Commissioning Groups need to nurture new talent as it emerges from vocational training schemes with innovative mentored dual hospital-community roles to help trainees build up experience and confidence.
And finally, we as a profession need to let it be known that we are doing a fantastic job, in spite of increasing workloads, more boxes to tick to gain points for QoF, a tsunami of CQC inspections, revalidation and appraisals and funding cuts. Patients at least appreciate us - which is more than can be said for politicians.
Dr Tim Morton is chair of Norfolk and Waveney LMC
Norfolk and Waveney LMC proposed a motion for the LMC conference 2013, ‘that conference calls upon GPC to urgently raise the developing GP workforce shortage as a significant patient safety issue. This shortage is likely to worsen rather than improve with the increasing demands on primary care, exodus of senior GPs taking early retirement, medical students opting for hospital careers and a move to four year vocational training.’
This will be incorproated into motion 16, ‘that conference notes the current workforce crisis in general practice is being accelerated by increasing workload and stress, and falling remuneration and morale, and calls upon the Government to take urgent measures’.