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Don't expect help - we need to tackle the recruitment crisis ourselves

Ultimately GPs will make the biggest difference, argues Dr Kamal Sidhu, not politicians

GP recruitment and retention crisis has received unprecedented political attention and media coverage in the last few weeks. Whilst it was a refreshing change to hear the health secretary acknowledge the issue, yet another review of the workforce issue has been commissioned (despite excellent fact-finding and recommendations from the poorly-publicised workforce task report and Centre for Workforce Intelligence reports), it was also disappointing to hear the NHS England chief Simon Stevens to suggest that we must reflect on the damage such issues have caused to the cause of general practice. Of course, in the same speech, he did not forget to mention the NHS England staffing shortage and funding constraints.

The cynic within me says that we are being forced into the corner, asked to accept other alternative untested models of care that threated a model that deals with the 90% with less than 9% of the funding.

Some say that the issue is cyclical and will go away and I really hope so, but do not believe that will be the case. Currently, it is not easy for any practice to recruit but many areas are disproportionately affected, especially the north of England, and more so if you are away from a city and work in an area with high deprivation. This was very much acknowledged in the reports mentioned previously and follows the inverse care law. I work in an area that ticks all of these boxes. Many local practices have struggled to replace those retiring or emigrating, despite offering flexibility of salaried or partnership and full-time or part-time work. Whilst the national discussions, reviews and negotiations continue, there appears to be little hope of any immediate relief or measures to ease this issue.

I am currently one of the six directors of a GP collaborative, South Durham Health CIC, and we are in the process of writing an open letter to interested parties, including the area team, CCG and local MPs. We want to highlight the crisis and work together to some immediate local measures to approach the problems of the recruitment crisis, as we are disproportionately affected in our area.

Think global, act local

For any hope of protecting one of the best and most cost-effective health systems whose fundamental success relies on the model of general practice, it is absolutely essential that we take the matter in our hands and take local and regional steps. We must work with our patients to make them aware of how desperate the situation is and how close we are to an end to the current model of general practice. We need to lobby with patient groups and MPs to highlight our concerns.

We also need to work with our CCGs, our colleagues, to secure support for the worst-affected practices. We need to be asking for support from our area teams especially at this critical juncture when PMS reviews are upon us. But it is also important that the CCGs, LMCs and area teams are mindful of how overstretched we are amidst the talk of seven-day general practice.

Funding alone is not going to be enough. We need better infrastructure and golden hello schemes. We need local campaigns to promote why we are still doing the job and what it really means to look after someone from ‘cradle to grave’, the phrase we use so often. We need to target schools at sixth-form level, medical schools and foundation doctors to promote a positive image of being a GP, and impact we make on the lives of the population we look after. We need to become better at celebrating our own contributions and what we are good at: looking after an individual rather than a disease.

Some of our local colleagues have served tough areas for years, showing great commitment. So we need to tap in on their expertise and support them to be able to work longer with local incentives – perhaps just recognition, additional leave, and support. Let’s bring in and support more training into such areas at all levels, including foundation years.

Some areas have already started to look at federated models of training as well as federated locum banks. To this end, our local GP collaborative-cum-federation is taking the initiative to work towards local solutions. But if we keep waiting for someone else to sort this out, the wait will be painful and endless. It is vital that we all put aside our scepticisms. Only then, we can survive and preserve such a valued health system. Ultimately, it is our own problem and however disgruntled we may be with the state of affairs, anyone who’s proud to be a GP is a part of the solution.

Dr Kamal Sidhu is a GP in Country Durham, and one of the six directors of South Durham Health CIC.

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Readers' comments (13)

  • interesting analysis, but nothing you've said actually solves then problem.
    considering the problem is a simple one: it is not economically worthwhile being a salaried GP or a partner. Hence locum or emigrate.

    Solutions either deal with this problem or pretend it does not exist. politicians seem to struggle with simple solutions.

    Forcing doctors to work by draconian means appears silly, the proctivity of GP's is far above any other area of medicine in the UK. surely utilising this would be useful

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  • You may be as idealistic as you like, but if your pay is cut year on year with an ever increasing workload such that you get a 50% pay cut per item in 10 years, with increasing litigation and controls and criticism and exhaustion at the end of 12 hour days, everyday you work, then it is wrong both morally and ideologically to ask others to join you in an increasingly impossible workload dimension. So, Dr Sidhu, before you extol virtues, consider this - would you like imposed Contracts year on year if the DOH so feels.
    Rather, tell all not to join

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  • Ivan Benett

    At last, a positive view of General Practice in these pages. How refreshing. Well done Dr Sidhu. It's only with a positive frame of mind will we save our profession.

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  • A positive view of general practice, are we reading the same article? "How close we are to the end", "how desperate the situation is" , does not sound very positive to me.
    I have spent the last 18 yrs telling friends and family that if you do not like your job, get another and that I would carry on working if I won the lottery. Now I would be ringing the area team with glee to give notice the next day, and would probably have disappeared by Monday to leave the problem to them.
    The state wants the yanks to move in, and the public place no value on primary care. Area teams are either run by idiots or there is a conspiracy to destroy General Practice, I will leave the reader to decide which it is. If only the wife would agree to emigrate. As it is I will have to hold onto the end and hopefully at least make some profit when the sale of goodwill is allowed and big business moves in.
    Not a good career choice for anyone now.

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  • Lol. You make me laugh. What do you think us businessmen have been trying to do for the last decade? If it was truly in our hands we wouldn't be in this mess.

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  • Good luck to Dr.Sindhu

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  • Azeem Majeed

    I enjoyed reading Dr Sidhu's article. Federations can help general practices address some of the challenges we face, as I outlined in an article published elsewhere. But we also need to address the funding and workload pressures that underlie many of the problems in general practice; and the consequent problems with recruitment and retention.

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  • This comment has been moderated.

  • Vinci Ho

    (1) It is a fine line between politically correct diplomacy and dangerously flawed hypocrisy . I do not have any problem for anybody to play peacemaker in any battle but one has to be very careful what one wishes . Once again , are we trying to provide patching for the consequences or are we dealing with the origin. What is the origin of this mess ? Deep down , I am sure we all know the answer.
    (2) Some disrespectful person told me once that people like Dr Arnold Elliot and William Beveridge were well dead and things like NHS with GPs guarding the gate should not exist anymore . Yes , while I agree that ways of delivery need modifications , old principles are 'die hard' , ladies and gentlemen . NHS was founded on principles of social justice and its flag cannot come down .
    (3) Majority of our patients really appreciate what we have been doing to them throughout the years . This is particularly so with GPs simply because of continuity and an established long term relationship. But patients , people of the country , are misguided and miseducated by these politicians and their propaganda media . This is the modern version of 'ignorance' , one of the five Giant Evils William Beveridge was talking over 60 years ago. On top of this , people are locked in the rest , Squalor(how many more depressed patients we have come across?) , Idleness(poverty at work despite lower unemployment rate?), Want remains and Disease( we know damned too well). Again , what is the origin , considering we are officially out of recession according to the rise in GDP(if you believe solely in GDP)?
    (4) We suffer because our patients/people suffer more and these politicians are not giving us the 'tools' to help the sufferers. We are simply stuck and squeezed as the 'middle man'.
    (5) Hence , it is not surprising the middle man wants to walk away . That is happening to all medical professionals:

    'Increasing numbers of paramedics are leaving NHS ambulance services, according to figures obtained by the BBC.
    Senior staff say remaining paramedic crews are under greater pressure than ever before to meet demand.
    At least 1,015 paramedics left their job in 2013-14, compared with 593 in the same period two years earlier.'
    BBC news (Health)on 9/10/2014.
    (6) Yes . It is easy to say to them ,'we should tell them how good this profession is and encourage more people to join.' Say that to the young ones about GPs , about paramedics , about midwifery , etc? This will go no where if one only tries to put the cart in front of the horse , attending the consequences and neglect the origin.
    (7) For the young ones( students or doctors ), open your eyes wide and get a full understanding of the ins and outs of what is going on . Typically , medics like to distance themselves away from politics but as I said before , knowing politics is different from involving in politics. Do not need to believe in what anybody said(including lunatic like me!). The truth is we need more of you to join general practice solely because the flag of NHS needs to carry on flying . We need the next generation GPs to stand up against any evils trying to destroy general practice , NHS and hence social justice. The job is a mission. It requires audacity and bravery to stand up against the tides as you protect your patients. Of course, be prepared to pay high price. At the same time, nobody can stop you from leaving .
    I was talking to Rob( our LMC secretary) a few days ago , we agree that it is not down to old farts like us to tell you what you guys need to decide for your future. For me, I am just glad I do not 'belong' to any organisation and my only 'baggage' is my own surgery .
    (8) I was crying in joy not sorrow when I saw all these young students in Hong Kong right now,voluntarily (not influenced by any so called spiritual leader or political party) stand up against a tyranny stepping over social justice , fairness and liberty........

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  • What THe GMC and and National health do to the GPs will make the biggest difference in recruitment crisis.
    GPs are little pawns played around and eaten by the big fish

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  • "Ivan has been a full time GP principal in Central Manchester for 28 years. He has held various posts in GP education, on the LMC executive, as Chair of Medical Audit Group. He was then PCG chair and later chair of the PCT professional executive committee until 2005. Following this he gained a postgraduate diploma in Cardiology and became a GP with a special interest in cardiology.

    He has worked closely with the cardiac network and developed primary care pathways for cardiology. He has been on the NICE guideline group for Chronic Kidney Disease and Post-MI care and the NICE topic expert group for Quality Standards in Heart Failure and CKD care. He is a Fellow of both the Royal Colleges of GPs and of Physicians. He is now Clinical Director of the Central Manchester Clinical Commissioning Group and is Primary Care Champion for the Greater Manchester Healthier Together programme."

    SO, very much one of "them" and not one of "us" I would dare to suggest??

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