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Gold, incentives and meh

If GPs are lazy and overpaid, why does nobody want to do the job anymore?

Government’s disinvestment in general practice risks patient safety and threatens the sustainability of general practice, argues Dr Dean Marshall

We are currently in the middle of a recruitment and retention crisis yet politicians refuse to accept reality. At the recent Welsh LMC conference Paul Drakeford, Welsh Minister for Health said ‘talking us into a crisis mentality is damagingly wrong’. In my view, ignoring what is plain to see is dangerously wrong.

Changes to our contracts, years of underfunding and pay cuts, pension and tax changes and an ever increasing workload are resulting in droves of GPs in their fifties retiring early and many younger ones dreaming of doing so. We can no longer rely on GPs taking 24-hour retirement and becoming locums.

As for bringing in new blood, the current proposal is for 50% of training places from 2015 to be taken up by GP registrars therefore a yearly intake of 3,250 is required. This will result in an additional 12,800 FTE GPs by 2030 according to the Committee for Workforce Intelligence.

In 2012 we managed to recruit 2,725, far short of the target. If we continue at this rate we will need to find 1,500 more GP trainees by 2015.

Arguably improvement in training and technology mean that the GP role has changed-many problems currently dealt with by GPs could be resolved by pharmacists, nurses or even the patient themselves- however access to a GP is what the public wants and what they have been promised by politicians.

Nowhere is the crisis more apparent than in remote and rural areas across the UK. Wales and Scotland are worst hit at present but how long before England faces its own crisis?

There have always been problems recruiting doctors to work in remote and rural areas but changes to demographics and lifestyle choices seem to have intensified the problem. We are used to stories about problems trying to attract GPs to work on remote Scottish islands, but when an area like Frinton on Sea in Essex is down to just one GP per 8,000 patients, there’s no denying the problem has reached beyond remote, rural and run-down areas.

Experienced GPs to problem areas

In the past a variety of solutions have been proposed. In Scotland, for example there have been attempts to encourage medical students from rural areas to return to train and work where they grew up. This has been met with varying degrees of success.

When practices have managed to attract trainees to rural areas they have made huge efforts to retain them to work in the area once their training is complete but again this has been met with only limited success.

If we can’t even attract young doctors to become GPs then perhaps we need to look at those currently doing the job and ask – what would it take for them to consider working in a rural practice?

Unfortunately adverts in magazines and online that point out the beautiful scenery, opportunities for outdoor pursuits and low cost of living doesn’t seem to work anymore.

So it seems we have to think differently now. Perhaps we need to stop concentrating our efforts mainly on trying to attract trainees and newly-qualified GPs to these areas and instead turn to those in the mid part or towards the end of their career.

Those who are looking for a change or a new challenge- including those who don’t currently realise that they are.

We also need to look at more innovative ways of helping practices in rural areas –such as buddy systems, where GPs can work in each others practices for a length of time to experience different ways of working, or offering inducements like increased holidays, properly funded study leave and sabbaticals alongside additionally funded staff and guaranteed income levels.

The current contractual and funding arrangements we have don’t allow these types of things to happen and this coupled with reluctance amongst politicians and managers to admit there is a major problem means the problem isn’t being addressed.

Politicians are bashing GPs as they are looking for someone to blame for the current problems of the NHS which in reality aren’t about contracts but about people living longer with more complex health problems and politicians and the media need to realise the damage they are doing. If GPs are lazy and overpaid, why does nobody want to do the job anymore? Government’s decisions are killing general practice.

Medical students don’t want to become GPs because of negative comments from politicians, media and sadly often hospital doctors –who don’t actually understand the problems GPs are facing.

And besides, creating extra training places won’t solve this issue. The average age a female GP retires from general practice is 37. Training more people to do a job that they won’t want to do when they qualify is self-defeating.

While it easy to think this is a problem for Scottish islands or north Wales, recent figures in Pulse have shown that it’s a problem affecting all parts of the UK. The East Midlands and East of England regions have just 63 GPs per 100,000 patients, and London has just 66 per 100,000.

The NHS in Scotland and Wales have been grappling with the problem for many years but NHS England now needs to accept it has arrived in their area now and it’s not going to go away any time soon.

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

Readers' comments (17)

  • Unfortunately the class of politicians we have mean we are stuck. they are so short sighted and we have not helped ourselves.

    Many of us have warned of these events but still we still are not being pragmatic enough

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  • Primary care is being destroyed by design . This is to pave the way for much more extensive privatisation in the next parliament . If the tories can precipitate industrial action so much the better . Just stop doing OOH work -we can't be blamed for that because thanks to the daily mail no one thinks we do it anyway .

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  • London has 66 gp/100,000 - This would be 1500 patients each . However this is not 66 WTE.

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  • I do not personally know any GPs in London who claim to work full time...........

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  • I as a trainee am sorely tempted to return to hospital. I will get more respect there for less arduous work. I will give less of myself and have more time for my family and for me. Why should I go the extra mile for politicians who think I'm lazy and an ungrateful public with an insatiable appetite for Their healthcare wants (not needs)? Crisis point was reached LONG AGO

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  • FWIW, it doesn't help when practices in North Wales put in their ad "Welsh Language preferred". LOL! Good luck with recruitment there then :-)

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  • The government may like to think that it is winning but will ultimately end up the BIG loser!

    I am very close to considering leaving the UK after 12 years "hard labour" and if I do I am sure many will follow me.

    The lack of any conviction politicians together with the existence of too many bleeding heart socialists are what will lead General Practice, and indeed the entire country into total chaos....and no one else will be to blame but the government and a delusional general public who need to ditch this notion that they are automatically entitled to everything for nothing!

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  • For years politicians aided by the media have been demeaning GP's ... now they will pay the price ... and it will be a high one to convince a generation of new doctors to take what used to be a great career.

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  • Massive and unreasonable demand by the public . How are we meeting it? By bending over backwards! Has no one ever watched super nanny ?!

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  • Took Early Retirement

    A very interesting take on it and well put. I cannot disagree with you. However, here in southern England, where I have been in urban/going-on-inner-city practice for 29 years, personally, I'd love the extra money that goes with a rural dispensing practice. I'd cope with having to go a few miles to a visit, because with urban traffic these days, ours take just as long. I remember a colleague who worked near Salisbury saying he couldn't remember the last time a patient of his took an overdose! I remember another, back in the dark ages, who said he only had to do one night visit a MONTH- when we were averaging 2-3 per night.

    Urban GPs have a massive burden caused by the end-stage social-pathology that masquerades as disease these days, and for which there are no LES's or QoF points. I have a large number of appointments taken up with GANFYDs for employment appeals, blue badge refusal, requests for a different council flat etc, and above that the genuine demand of a poor, and therefore unhealthy, population.

    I'd like to see urban General Practice fail first. (I think it will)

    GANFYD= "Get a note from your doctor".

    DOI- Leaving NHS GP work in 29 days and 18 hours, at the age of 57. Refuse to take it anymore.

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