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Crisis point: GP partner shortage hits practices

Even in leafy English suburbs, practices are waiting over a year to fill a partnership vacancy. Jaimie Kaffash looks at why no one wants to be a GP partner any more

Cover image June 330x330

Murmurings of an impending GP recruitment crisis have been circulating for a while. Now, according to the GPC, that crisis has finally arrived.

An internal briefing paper – seen by Pulse – says the effects could be ‘catastrophic’, with general practice suffering permanent damage.

A Pulse investigation shows that one in 10 partnership vacancies goes unfilled for more a year, and a quarter are vacant for more than six months.

This is putting immense strain on to practices, with workload mounting and GPs struggling to meet patient demand.

Even practices in prosperous parts of the country are finding it hard, with some resorting to offering £20,000 ‘golden hellos’ to attract partners.

The situation seems to be rapidly deteriorating, and there is little sign of any reprieve.

‘The time has come to declare that the workforce gaps in general practice have reached crisis point’

GPC briefing paper on the recruitment crisis

Toxic cocktail

Pulse has learned that education chiefs have stepped in with thousands of pounds of emergency funding to support practices in one area that is down to one GP per 8,000 patients. But this is little more than a temporary fix for a toxic cocktail of problems in general practice.

The GPC briefing paper lists rock-bottom morale and rising workload as major reasons for many GPs rejecting partnerships and choosing instead a better work-life balance as a sessional GP.

‘The time has come to declare that the workforce gaps in general practice have reached crisis point,’ it declares.

‘There is an unwelcome lack of certainty in responses to advertisements for partnerships and sessional roles. Overall, the picture would suggest that practices around the UK are unable to recruit and replace GPs.’

The GPC’s conclusion pulls no punches: ‘The effects on patients and profession alike will be catastrophic.

‘Without drastic steps of action taken now, UK general practice will suffer permanent damage. The truth is that corporate bodies will want to fill the gap if practices start to fail.’

‘If we cannot recruit anyone here, how is the rest of the country doing?’

Dr Andy Ward, a GP in the seaside town of Weymouth, Dorset, has personal experience of the difficulties described in the GPC paper.

He says: ‘One of our partners left two years ago. We advertised locally and had no applicants. We then headhunted somebody, who turned out not to want to stay. We advertised nationally back in January, and had no applicants at all.

‘We are not in a part of the world where we have had problems before. We are a small, friendly, high-earning practice. Morale here is good and it is a great place to live. If we cannot recruit anyone here, how is the rest of the country doing?’

At the other end of the country, practices are experiencing similar problems. Dr Jane Lothian, medical secretary of Northumberland LMC, says: ‘My own small practice gave up trying to recruit doctors and ended up building around nurse practitioners. We were looking for a year and a half.’ 

She says the problem is getting worse in her area, and that practices are suffering badly: ‘In the south east of Northumberland, where the old coalfields are, it has been quite a problem and it is getting worse. Some practices in have up to three doctors’ worth of vacancies.’

Why does no one want to be a partner anymore?

• ‘Alarming’ increases in the levels of stress felt by GPs.

• Denigration of general practice by Government and in the national media.

• Younger doctors demanding more flexible career options and current training leaving GPs ‘woefully underprepared’ for life as an independent GP.

• Lack of control over work-life balance and underinvestment in general practice.

• Lack of support for returners and retainers.

Source: Recruitment of GPs: Time to take action for the future workforce, presented to the GPC April 2014

Few candidates

The problem is spreading. A recent survey of 270 practices across the south of England by Wessex LMC shows 70% had a vacancy to fill in the past year, of which almost one in three was unsuccessful.

Cleveland LMC found GPs receive an average of three applications for a partnership post; typically, one of these pulls out and one is unqualified, leaving a single potential candidate. 

Pulse has learned that one practice in a ‘relatively leafy, affluent’ part of Doncaster, South Yorkshire, has had to offer partners a £20,000 ‘golden hello’ to join and stay at the practice.

Local LMC chair Dr Dean Eggit says such measures are not surprising. He has found that a number of practices in his area have long-term recruitment and retention problems.

He says: ‘My last understanding of the “golden hello” was that it was used in the early 1990s, when there was exactly the problem that we are starting to get to now. Patient demands and expectations cannot be met, so there are long working hours et cetera. There are not enough doctors nationally.’

A Pulse survey of 442 GPs across the UK confirms that many practices have to cope with vacant posts for long periods. More than a third (38%) have had to recruit a partner in the past 12 months, and the process lasted more than six months for 25% of them and in excess of a year for 10% of respondents.

‘‘Three of us are going in two years. The effects are insidious’

Dr Eamonn Jessup, chair of North Wales LMC and a GP in Prestatyn

In North Wales there have been longstanding issues for GP recruitment and retention, but Dr Eamonn Jessup, chair of North Wales LMC and a GP in Prestatyn, says his practice has spent ‘thousands’ on advertising posts in the past 12 months, as they are four GPs short of the nine required, and have had no suitable candidates.

‘We have not had a single applicant,’ Dr Jessup says. ‘Three of us are going in two years. The effects are insidious: the numbers of referrals we are sending off is increasing because we are not now able to review the patients. Prescribing is going up.’ 

This has led the practice to consider drastic measures: ‘The next step for us is to appeal to those GPs losing MPIG in England to come and join us. It’s business. The fact is, we are desperate, and dare I say it, it is dog eat dog.’

Meanwhile, locum agencies and chambers are booming. Dr Richard Fieldhouse, clinical director of the Pallant Medical locum chamber, based across the south of England, and chief executive of the National Association for Sessional GPs (see Day in the Life, page 104), says that around 50% of his chamber’s new members are ex-partners who are joining despite often experiencing a pay cut.

He says: ‘They feel that the chambers is a more supportive environment than a partnership; they can just focus on quality of care.’

Overwhelmed

Recruitment infographic-june

Conversely the recruitment crisis means the chambers are overwhelmed with work. Dr Fieldhouse says: ‘In just one CCG area, we have had 12,500 requests for sessions to be filled and we have only been able to fill 9,000 of them.

‘The reason for this is that practices cannot recruit partners or salaried GPs, and doctors are going off work stressed.’

It was only three years ago that there was another workforce crisis – but that involved salaried GPs being unable to obtain partnership posts, with the RCGP posing the question at its annual conference: ‘Is the profession doing its newly qualified colleagues a disservice with the lack of partnerships available?’

Now, for perhaps the first time, young doctors do not see partnerships as being an attractive career path and are opting for sessional roles.

Dr Lothian says this is leading to practices in Northumberland thinking about offering innovative ‘joint posts’ with secondary care to attract younger doctors to general practice. She says: ‘We’re setting up joint posts so young doctors can rotate through primary and secondary care after they have done their MRCGP. We see they still want variety. Some practices are looking at offering flexible posts – terms out of the contract, that sort of thing.’

Experienced GPs leaving the country or retiring is also exacerbating the problem. GPC deputy chair Dr Richard Vautrey says: ‘There are large numbers of older GPs who are retiring early. They are struggling to cope with the workload and constant bureaucratic annual change in what is asked of them, and so with the punitive pension changes, they have decided that enough is enough.’

Those causes of the current crisis are not going to go away anytime soon, but there are signs NHS bosses recognise the situation is unsustainable.

The RCGP is calling for the NHS to make it much easier for GPs to return to practice. Currently, GPs must apply to their deaneries, who then identify a practice where they can be mentored before they go back on the performers list. RCGP chair Dr Maureen Baker has made it a priority to remove these barriers. These ideas are being looked at by the Department of Health.

Fire-fighting

In Essex, Health Education England has offered practices a share of a £400,000 firefighting fund, after Pulse revealed in January that problems with recruiting had left one area in the region – Frinton-on-Sea – with one GP to 8,000 patients. The money is only a temporary solution designed to hire locums and increase practice nurse numbers, but GP leaders have welcomed the intervention.

Essex LMCs chief executive Dr Brian Balmer says it is ‘early days’ but hopes the additional funding will alleviate the immediate problems: ‘We are wanting to get on with it quickly, and it will be support for sessional doctors and more apprenticeships.’

And in a more unusual step, a housing developer in Carlisle, Cumbria, in a joint scheme with the local authority, has offered GPs a discount on home-buying in a bid to attract them to the areas in which it is currently building.

In an offer open until March next year, Story Homes is offering a £1,000 discount for every £50,000 spent by GPs on its developments in four areas of the town.

‘The number of jobs coming up is reducing, simply because nobody has money to buy doctors anymore.’

Skill-mix

Pulse’s survey shows that although vacancy rates remain high, they are slightly lower than those shown by a similar Pulse survey last year. Overall, there was a 6.4% vacancy rate, compared with last year’s figure of 7.9%, although this still represents a steep rise on vacancy rates of 4.2% and 2.1% from similar surveys in 2012 and 2011, respectively.

Dr Eggit says this drop in vacancies is a sign plummeting incomes are starting to limit the number of partnerships practices can offer, and that some are having to look for other solutions.

He says: ‘The number of jobs coming up is reducing, simply because nobody has money to buy doctors anymore. In my own practice, we would love to be able to recruit but the money is not in the pot.’

Dr Vautrey concurs: ‘Practices are experiencing big funding cuts now, and if they are PMS  they face even bigger cuts just around the corner, so they are having to seriously look at whether they can afford to replace GPs who are leaving. 

‘Some also have reluctantly accepted that they can’t recruit to vacancies and therefore had to look for other alternatives in terms of skill-mix.’

The Government has made a great play of its plans to boost GP numbers in the future, although its target of having 3,250 trainees entering general practice has recently been delayed by a year until 2016, which offers little help to practices wanting to recruit now. The recruitment problems in general practice look set to get much worse before they get better.

 

Ten steps to successfully recruit a partner

Read Dr Simon Poole’s quick guide on how to find a new GP

Related images

  • Recruitment infographic-june

Readers' comments (17)

  • Vinci Ho

    We are lucky to recruit two new young partners last year, one of which was our salaried GP for 2 years prior and she was a GP registrar of our practice. It is about enthusiasm and understanding what is required from a partner in such a difficult circumstances . Of course , we worked hard to develop good relationships amongst working colleagues .

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  • Shortage of GPs is a factor.However, there are more concealed factors for recruitment and retaining. GP partners and practices need to learn how to improve relationship, the offers they give. The historic " with a view to partnership" is putting applicants off.
    Offer full parity, make the new doctor welcomed instead of creating a rejection reaction. Give good induction, give a chance to the new doctor to familiarise with patient population, promote the new doctor to patients and so forth.

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  • The LMC conference was a perfect opportunity for GP Partners represented by their LMC to do something. But the majority vote was basically to do nothing. This has sent a strong message to those of us who are salaried, locum or portfolio drs that the majority of GP Partners have a handle on things and don't feel any action is required. In that case the majority of GP Partners are going to have to sort out their own mess as there are no locum drs that I know who will touch a partnership. The locum drs that I work with would rather go into private practice or change careers than take on a NHS partnership. It's less to do with money and more to do with a difference in values and frustration at the current system.

    I do have sympathy for the minority of GP Partners who actually wanted to get out of the contract and wish them the best of luck.

    It's effectively every man for themselves.

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  • I have been a returner, retainer, salaried and now since April a partner at the same practice. It is a well positioned well functioning stable partnership in an attractive town. I went into it with the knowledge that it would be more work (6 sessions being in reality nearer 8 with the hours I put in after surgeries and evenings) and the last 2 months by the time I have paid my employers and employees pension contributions and put money aside for tax I have ended up with less income than I was paid when I was salaried. I did this with my eyes open, I am lucky to be in a happy functioning working environment and felt it was the right time for me to be more involved in running the practice, but it is a little galling when there is no prospect of things improving financially in the near future. It is a shame, as this was what I aspired to during my GP training and now I am here I have to wonder would trainees today feel the same way when they see how hard the partners are having to work for no extra reward (and possibly less when you take into account extra expenses) No wonder it is difficult to recruit GP partners in less attractive areas of the UK.

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  • I have been a sessional GP in the same town for a while and have often been told by local Partners if you work part time we won't consider you for partnership !! Where does that leave female doctors who form a big part of the GP workforce

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  • The concern here is the Goverment is happy with this situation. What I struggle with is it
    A- people don`t want partnerships , due to the various factors in the column above i.e, stress, pay, morale, poor deals on joining a partnership?
    B- We don`t have the numbers?
    If its A then the concern here is that , this will leave the sessional GP`s to the mercy and inticement of Private companies, i.e reasonable starting pay, company cars, less stress ( at the beginning, until profit and targets become more prevelant).
    Either way we are screwed.
    We need a sensible alternative model, that we either present to the Goverment, or we go our own way, like the Dentists, if the Goverment refuse to work with us on saving Us and the NHS from collapsing.

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  • Anonymous | GP Partner | 05 June 2014 9:31am

    'We need a sensible alternative model, that we either present to the Goverment, or we go our own way, like the Dentists'

    the point is there was an opportunity to look into this but the majority of GP Partners have rejected the 'alternative models' view as a result some GPs who could have been future GP Partners have now lost interest and are looking at other options including; portfolio careers, locums, innovative salaried posts, healthcare related careers (management etc), emigrating or even changing careers. It does not make sense to take on very risky work (liability financially and clinically) with almost no rewards (and i don't mean financial) within a system which is working against the ethos of general practice. GP Partners had a chance to reach out to other GPs but by their own inaction they have blown it. I'm sorry but it's every man for themselves now.

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  • To be a GP in current NHS which insists on cheaper hypoglycaemia inducing sulphonylureas as 2nd line in Diabetes treatment,,irrespective of expensive treatment of of hypos in 2ndry care and dangers including death,RTA with hypos,where GPs are not allowed to also prescribe Blood sugar testinother dangers of hypos including death;it is only a foolhardy person would opt to continue working as a GP in The UK.there are other NICE licenced medications to replace sulphonylureas as second line in Diabetes.EBM as manifested in Prof Anthonty barnet's comments o dangers of sulphonyureas induced hypos which are similar to Insulin in the first 3 years should be addressed

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  • Come now, You are being disingenuous, GPC. You are aware that Contracts can be imposed, pensions increased, pay cut, Promises such as MPIG reneged on, GPs going bankrupt, workloads approaching 12- 12 hours a day, falling pay, depression and burnout, nevermind the vilification in the press. AND YOU really, truly want more poor folks to come in and get similarly broken when you will not or cannot help the ones you have already? Really?

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  • There was a post-2004 boom time for partners who created this 2-tier workforce when it was convenient for them...

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