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Dr Chaand Nagpaul: 'Grassroots GPs are offering to dig politicians out of their own mess'

GPC chair Dr Chaand Nagpaul says the GPC’s survey of 5,000 GPs offers real solutions to the crisis in general practice

If the government needed any further evidence that GP practices are being stretched to breaking point they need only to look at GPC’s latest survey of the profession. But they should also listen to the clear solutions that grassroots GPs are offering to help dig politicians out of the mess they have made of general practice.

More than 5,000 GPs in England responded to our poll and unsurprisingly it revealed that that workload pressures were unsustainable in every part of the country. Eight out of ten GPs in all English regions said their workload was either excessive or unmanageable.

The worst affected areas were the South East, the West Midlands and Yorkshire and Humber with 86% saying their daily routine fell into this category, but the lowest response was 83%, showing a remarkably uniformed national picture. From the North East to the South West, from the big urban cities to far flung rural areas, the view is the same: GP services are being spread so thin they are struggling to provide even basic care to their patients.

The alarming consequence is that more than 8 out of 10 GPs say that they are unable to provide safe and quality care. Therefore if the government seriously wants to improve patient safety, it must first address this environment of engulfing unmanageable workload pressures on GP practices, rather than continue with the flawed Care Quality Commission inspection regime, with its cumbersome and expensive inspection process taking both time and resources away from GP practices, and in turn exacerbating GP pressures.

The reasons for these survey findings will already be clear to every GP reading this blog. We’ve been subject to a decade of underinvestment at the same time as rocketing patient demand, spurred by an ageing population that needs more complex care. Staff shortages and more work being moved from hospitals into the community have added to the long term pressure and matters have not been helped by a catalogue of failed political projects.

The decision to outsource back office operations to Capita has been an unmitigated disaster which has delayed the transfer of patient records and the ordering of medical supplies, leaving GPs and their staff with another impediment to doing their job effectively.

In our survey, GPs however look beyond the problems and offer real solutions. Increased funding, as the GPC has repeatedly called for, is at the heart of repairing the damage done to general practice.

But other measures need to be taken. GPs call for the increased provision of enhanced community nurses to manage vulnerable housebound patients and more mental health workers, demonstrating that GPs get what politicians don’t: namely that we need a more flexible, specialised primary care team in our communities to support GPs. There is also a clear call for greater provision of self-care support to patients for both minor illness and self-management of chronic diseases, to reduce avoidable demand

Many of these proposals were mirrored in the BMA’s Urgent Prescription for General Practice, which NHS England accepted a few months ago. But while that acceptance was welcome, what GPs want to see is one thing and one thing only: delivery. We need the promised funding, the promised extra support and the promised additional workforce to begin to arrive in GP practices throughout the country. And we need the short term mess of the CQC and Capita to be addressed in full.

Having got the government to recognise the enormity of the crisis in general practice, GPC is now pressing hard for the government to deliver on their promises, and is putting in place a system to track this with the help of LMCs. The time for warm words is clearly over: it is time for ministers to make their pledges a reality.

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Readers' comments (16)

  • Problem Analytics - there are two factions inside the Conservative Party. The first group is made up of older, traditional (dinosaurs) who have money/position and influence the centre ruling body with sound bite ideals that somehow attack the bone idle, fake sickness brigade but have no grasp of the desperation of ordinary folk who are the complete opposite to their, safe, monied existence. The second group are the do-ers- MPs, well meaning, influenced by the first group but looking for a middle ground compromise that keeps everyone happy. THE REALITY: Change for change sake has brought us all to where we are now - the NHS is unsustainable right now - either higher taxes under Corbyn or lower taxes and private under May - ITS DECISION TIME!!!!

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  • Brexit was the wrong referendum - designed to distract from the real question - what can our nation afford?

    Now we will waste all our energy on Art50, rather than on how we stay afloat.

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  • This guy can sure talk a lot and tell us everything we already know as to how bad it all is.
    He is really very, very good.
    He thinks pointing out all these problems for all these years is great.
    The real point, I could say all these things too.
    Bur NEVER EVER do anything about anything. His side kick is exactly the same.
    Every week, in and out, we have the same how dire is my valley stuff.
    But the CON trick is to do nothing and when they had the chance to ballot, they went AWOL.
    But they start spouting how terrible, terrible straightaway.

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  • Mess is the correct word. Severe underfunding of the NHS and the competition imposed upon it are drivers toward bankruptcy instead of profit. Mr Blair (for all his Iraq War faults) increased NHS funding to equal the EU average healthcare funding level and so radically reduced the waiting times for hospital appointments and operations. But the Tory led Coalition and now the Tory Government have reduced NHS funding to way below the level of all nearby EU countries. This has starved the NHS of GP trainees and Hospital staff. It is not clear why the Government has done this. It is true that the crashed banks in 2007 absorbed more than £1261bn of public money for recapitalisation and quantitative easing to get them barely into a position to lend credit again. But this was the Banks' fault for having lent our nation's wealth to people all over the world with no prospect of repayment. But we remain the sixth richest country in the World and therefore I suspected that the Austerity Programme is ideological rather than fiscal. Therefore we must all holler at the Government that it has to fund the NHS properly. It is after all paid for and therefore 'owned' by our taxpayers. It would help the fiscal situation if all earnings and profits made in the UK were properly taxed.

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  • Anonymous 12.32
    Do you create anything or just criticise others and belittle their motivations?
    You just criticise for criticism sake! Chaand has led the profession in very difficult circumstances ....He is a good leader and good man...

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  • To Felix Montgomery medical student.
    Why don't you mention a third way which would be to keep the NHS publicly owned but extra funding given to it through social insurance schemes and Co payments for seeing the doctor or going to the hospital? This is what they do in Europe. Can't a journalist from Pulse do a little article on how different European countries fund their Healthcare? Just for our education.

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  • Like all behaviour change, there needs to be an incentive to do so and and consequences for not doing so.

    It's all very well to wring our hands over the state of general practice but what incentive is there for this government to change?

    As a profession, we haven't given them one thing to cause them to break into a sweat. The LMC mandate for IA was rejected by the GPC because "NHSE are now listening to us and the Urgent prescription" I can see no deadlines for this - just aspirational ideas and a push to change the way we work.

    There are only 2 things which will get us out of this mess, and the first will still take about 5-10 years.

    1. Increase GP share of NHS funding to at least 12% and get rid of all the degrding micro-management hoops we have to endure to get this money into our global sum

    2. Become independent of the NHS and continue practising in the holistic way in which we were trained

    The 2nd will never happen because, even in the face of patient safety issues due to under funding, many of our Leaders still treat the NHS like a religion and have blind faith in it.

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  • The lack of any substantive mention of health and social care in the treasury Autumn statement speaks volumes to me.

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  • Survey, hand-wring, rinse and repeat.

    The basic function of the GPC is to serve the GPC. Nothing else.

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  • 12:32 is completely right 12:53

    No one doubts Dr Nagpauls character, I for one thing hes a great guy. The point has been that his tenure has been about highlighting difficulties we have known for years and echoed this time and time again. The facts are easy to ascertain...the govt doesn't want to listen and as a result of the gpcs "civilised manner" in dealing with the crises nothing has changed!
    its about to get a whole load worse as well with a 22 billion haircut the NHS is forecast to suffer by 2020. Do you think that by merely being a nice leader in difficult times the tsunami that is about to engulf the profession will abate???

    What is needed here is actual action that will force the hand of the government to release funds that are desperately needed to shore up primary care and not just , year after year pointing out that we dont have enough money;

    ACTION NOT WORDS.... the time has long passed for civility and the gpc are well aware what balloting the profession will achieve (mass resignation) hence they are avoiding it all costs

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