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Dr Dean Marshall: 'Patients are beginning to realise their local practice is under strain'

With many GP practices on the verge of breaking point it is time to launch a forceful campaign to inform patients, writes GPC negotiator Dr Dean Marshall.

General practice is under unprecedented pressure with many practices on the verge of breaking point. This is the reality that GPs are facing and this is why today the BMA has launched its new campaign, Your GP Cares, which is calling for the sustained investment that GP practices need across the country.

A key part of the campaign will be to highlight to the public the real obstacles that are getting in the way of GPs delivering the care that patients want expect. Many of these are already becoming apparent to patients although politicians and policy makers continue to ignore them.

The most pressing concern is that we are now seeing a relentless conveyor belt of workload.  GP practices are seeing a steady rise in the number of older patients needing longer appointments to manage complex medical problems which reflects the changing demographics in the wider population. By the end of the next decade those over 65 will top 15 million, up 5 million from today.  Many of these patients have complicated conditions that are not straightforward. By 2021, 1 million members of the public will be living with dementia while 3 million are expecting to living with or beyond cancer by the dawn of the 2030s.

I could go on quoting figures, but I know most GPs are already dealing with a heavy burden of complicated cases that is getting more and more pronounced. And crucially, they will also know that the Government is not providing the funding to allow us cope with this extraordinary rise in workload. Our resources have flatlined for years, while the cost of running a practice is continuing to rise. Practice expenses now account for 61% of all practice income.  This leaves no spare funding for GPs to upgrade their premises which in many cases are not appropriate to cope with the demands of 21st century medicine.

Given this climate it is unsurprising that patients are beginning to realise that their local general practice is under strain. Its most obvious manifestation is the difficulty in obtaining an appointment because of the volume of people who need them and the fact we don’t have enough GPs to provide them to patients.

This is why it’s the right time to launch a forceful campaign that doesn’t just publicise the problems facing general practice, but seeks to offer positive solutions to get us out of this worsening crisis. The solutions we need can be divided into three main areas. We need a sustained recruitment drive that gets more GPs working in local practices. We need a similar effort to recruit more practice staff. And we need to bring GP premises up to scratch so they are fit for purpose to deliver care to our patients.

Practically, we will be using direct communication to patients to get our message across in the form of posters and other materials. We will be lobbying parliamentarians and other stakeholders and continuing to draw attention to practices who are in trouble, as we have done recently with those affected by the withdrawal of MPIG.

Now is the time for the government to face up to the fact that general practice needs help – we cannot continue to stick our head in the sand and hope that the problems facing general practice will just go away.

Dr Dean Marshall is a GPC negotiator and a GP in Midlothian.

Readers' comments (12)

  • Do they really care?! It's all about 'me, me, me' and getting what they want, even if it isn't appropriate, and it's also a cohort of these patients that are making GPs struggle with their demands, or face complaints.

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  • Why not, in your forceful campaign begin to put mass resignation on the agenda? A threat for simultaneous resignation of all GPs from the NHS on the eve of the general election in May. This will get the Conservatives attention.

    Unless the DoH delivers a real plan to: 1. increased retention of GP's, 2. Increased training of GP's, and 3. increased funding of GP as per RCGP "Put Patient First Campaign", then mass resignation of GP's from the NHS from April 2015.

    The BMA could begin coordinating the practicalities of nationwide resignation of GP's from the NHS, to the private sector one month prior to the general election.

    Withdrawal of GPs from the NHS would end the NHS, suddenly destroying the election hopes of the Conservatives. This is a threat they would need to take seriously and so drive them to a better fairer deal at the negotiating table.

    Either GP's take a stand collectively resigning in unison, or GP's will leave the profession piecemeal to the prolonged but steady deterioration of the NHS.

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  • Although it would be great to destroy the tories, it would only lead to a Labour victory. And they have shown they can match the Tories in incompetence and corruption.

    We need to get behind as many independent MP's as possible, only chance of getting some competent individuals in

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  • I go to see my GP when I have a health problem, I come away worrying about him, how tired he looks, how exhausted he is, and how many hours he is working just to keep his head above water.

    Our GP's deserve so much more than this, it is appalling they way they after hounded from every angle over silly tasks that really are not necessary. Where has the trust in our GP's gone, it has been eroded by endless unfair criticism by this government who seem to have forgotten that GP's are indeed the NHS.

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  • Yes most patients do care and greatly appreciate their GP surgery and it's staff. You will always have people who are self obsessed and demanding. It's a sign of the times. It's the pressure on the whole NHS that makes us less able to cope with these types of people.

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  • I certainly care about the well-being of my GPs and their practice in Tower Hamlets. They do a brilliant job. As a "talking-therapy" psychotherapist, I have watched NHS psychotherapy services virtually wiped out over the last few years - under Labour as well the Coalition.

    What is still hard to get across is that there is an ideological thrust behind the processes that are presented and received as piecemeal 'problems with the NHS'. I despair when Miliband does a party political broadcast on the NHA and doesn't use the P word - privatisation.

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  • Oooops! - Miliband p.p. broadcast on NHA? I wish. NHS of course.

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  • it would be more efficient if specialist GPs were trained to eg take care of older people with complex problems..the training is outdated

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  • The problem is not training, the problem is resources.

    If more GP's retire, or immigrate abroad, and less trainees become GPs, then there will be a shortage of GPs - which is what we have. If you have the second lowest hospital bed numbers per 1000 people in Europe - which is what we have - then there are going to be many patients, who should be in hospital, in the community. Someone needs to care for them - who is it?

    As an aging population with complex problems increases, they will be require more input from GP's/District Nurses. On average a home visit takes me a half an hour, in the same time I can see 2.5-3x patients in the surgery. If with an aging population, visits increase, how will GP's manage to care for people safely without more GP's and resources?

    The objective is not to side with any one political party, but to use Mass Resignation as leverage, to obtain a fairer more sustainable deal in order to improve standards and quality of care.

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  • @8:25 - you are talking about consultant geriatricians. They already exist, but perhaps need better resources.

    It is kind of unfair to ignore them as a speciality completely - or try to replace them with a cheaper alternative.

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