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At the heart of general practice since 1960

NHS chief suggests GPs should 'reflect' on damage caused by raising alarm over state of profession

GPs should ‘reflect’ on the negative impact that raising alarm over the state of general practice may have on recruitment efforts, NHS England chief executive Simon Stevens has suggested.

Mr Stevens said there was ‘no question’ NHS England had to ‘pull out all the stops’ to improve the situation, there needed to be ‘balance struck’ between GPs raising concerns and putting off new recruits.

In the same speech, delivered at the RCGP conference in Liverpool today, Mr Stevens proposed that the ‘corner shop’ model of general practice was ‘past its use-by date’ and that practices should expand to employ hospital consultants and others.

He also admitted that NHS England got it wrong on the phase out of MPIG and that he wanted a ‘period of stability’ for general practice funding, for example with the reviews of PMS funding spread over four years..

But his comments over GP training provoked an angry response from GPs.

Mr Stevens said: ‘The reality is that it is time to take seriously the value of general practice in this country, it is time to “get real” about the pressures you are facing and it is time to get constructive about a range of actions that are needed to put general practice on a sustainable footing.’

But, returning to the problems facing the profession, he went on to say: ‘There’s a balancing act to be struck here - a conundrum. Quite rightly you are telling it as it is in general practice at the moment, as a wake-up call for those who work with you to respond … but the danger is that wake-up call sounds like a proposition to young doctors, that you want to steer clear of general practice.

‘So how to have that honest conversation without it becoming a self-fulfilling prophecy so that we end up with huge swathes of the country where training places that are not filled, I know that is something you will be reflecting on.’

But the remark was met with groans and heckles from conference delegates and a furious response on Twitter.

He added that GP trainers in the audience also had a responsibility to encourage trainees to take up general practice: ‘I was looking at the proportion of medical school graduates who choose to go into general practice and Oxford and Cambridge are amongst the lowest. A bit of a cheap jibe, perhaps, but one thing you could help us with is make more of the folks you teach at Cambridge more interested in taking it up.’

Mr Stevens also told delegates that while they may be ‘having it tough’ they should ‘keep in mind’ that NHS England staff are at risk of redundancy.

He said: ‘I have to tell you - you may rightly have it tough in your area, but I had to tell several thousand of my NHS England employees earlier this week they are going to be at risk of redundancy because we are going to be cutting our running costs by 15% by March 31. The consequences of that are there are going to be half the number of area directors there were before.

‘So you just have that context in your mind, as you’re dealing with folks who I’m sure are trying their best but are under a lot of pressure and some of whom may not be there on April 1st.’

Dr Jamie Green, a GP trainee in Northampton who attended the conference, posted on Twitter: ‘Let’s see what he knows about training? No he does not know, and no answers…’

Another tweet read: ‘Did Simon Stevens really just blame one of the question askers for the GP recruitment crisis? Dangerous ground. #RCGPAC’

Some delegates voted with their feet, and left the conference hall early, including GPC education, training and workforce chair Dr Krishna Kasaraneni, who tweeted: ‘#RCGPAC I have absolutely no idea what he is saying, I am off!’

Dr Luke, GP in Leicester, tweeted: ‘#RCGPAC Simon Stevens: heckles starting. NHSEngland making their in-house cuts= hint, why are GPs complaining as their businesses collapse??’

RCGP chair Dr Maureen Baker moved to quell criticism saying that it was positive Mr Stevens had recognised the ‘shocking crisis’ in investment and workforce.

Dr Baker added: ‘We now need tangible actions to follow his words and we stand ready to work together with NHS England to deliver the commitments to ease the pressures on GPs as soon as possible, and invest in improved services for patients.

‘The best possible platform for effective, integrated, patient-centred care in the community is general practice and we are pleased that Simon Stevens recognised this model and the role of federations in achieving this.’

 

Readers' comments (122)

  • have a close read of the comments from the following organisations ;

    NHSE
    RCGP
    BMA (GPC)
    NAPC

    then make a sentence with the words 'sold' and 'out'.

    what we are seeing has been planned - traditional General Practice is being destroyed and a new integrated salaried model is going to be implemented whether we like it or not.

    Within 10 years there will be no GPs. those left will be called medically universal general specialists ('mugs'). we will be another 'cog' in the wheel - i'm sure lots of 18 year olds will be thinking what an attractive career - work for virgin for 50k a year, one mistake and no career, micromanaged with no option to innovate or career develop and a 100k debt to boot (assuming you pass through all the increasing exam hurdles).... Or you could be a politician on 75k basic or daily mail journo on 100k.

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  • I've been saying for ages that the plan is to have salaried GP workforce employed by likes Virgin etc and now seems others cottoning on to real Tory agenda
    If anybody believes JH comments about protecting independent contractor status then they living on Mars. At least Andy Burnham truthful and admitting wants salaried service. Whatever happens, GP, as has existed since 1948, entering death throws. The current mode,l as we all know, is unsustainable and the burn out, early retirements and lack graduates wanting to become GP's is just testament to that. Patients are wooed by vote winning rhetoric that they will have access to 'their named GP' whenever thay want. As has been said before- cupboard understairs in homes for GP to just pop out of when Joe Public feels like it. A free service is used and abused and chickens like GP's coming home to roost and own fault for not standing up to the bullying we been subjected to and gross misrepresentation in media. We bow down as 'care about our patients'- admirable- who cares about us? Nobody!

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  • Recruitment is what they are most worried about. That is now obvious - we have a weak point.

    It's time to persuade the over 55's to just retire and the juniors to go elsewhere.

    Nuke it from space, it's the only way to be sure.

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  • If you listened to RCGP's helen stokes on R4 there are areas ( the impact of P/T work) where the RCGP is unwilling to recognize the negative impact it is having.

    The RCGP academic set up and generally academic medicine has created a generation of clock watchers who are not geared to deal with the realities of medicine.

    Medicine is very tough doesn't matter where or who - the UK did it so well. General practice is one of the last beacons. But you are a divided group - until that is recognised you will get more frustrated

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  • How to win friends and influence people the NHS England way!

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  • Yes, the fury was real. I was wondering who was typing so loud on his iPad two seats to my right. It was Dr Jamie Green, I am Dr Luke quietly twittering next to him...we don't know each other.... We were closest to Mr Stevens at the front! Us two didn't need to heckle, we shouted through Twitter. Was a surreal moment.

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  • Dr David Barrett

    He started off on the wrong note as well. He had an early stab at us for welcoming him to our conference where we were discussing interesting things such as "Primary care in the Amazon jungle" - what a cheap shot, I bet his researcher dug that out on the train up... It's poster, number 44 on a a stand in fact and on page 105 of the conference handbook.

    Alexandra Callear, Derby

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  • Dr David Barrett

    A good poster too, by Alexandra Callear, Derby.

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  • He should "reflect" on the damage his organisation and the DoH have done to general practice.
    I have left an excellent partnership because of their policies and could not, in all honesty, advise any young doctor to choose general practice as a career.
    How dare he blame those who have been on the receiving end?

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