Behind the headlines: Do GPs get ‘something for nothing’?

Rhiannon Jenkins analyses Labour’s criticism of GPs and its plans to ensure people can see a GP ‘when they want, how they want’

In his speech at the Labour Party Conference in Liverpool on 28 September, shadow health secretary Wes Streeting pledged to provide a face-to-face appointment to every patient who wants one.

Mr Streeting also told the conference he would be the ‘shop steward’ for patients and give them ‘the opportunity to self-refer to specialist services where appropriate’.

The BMA said Labour’s promise was ‘not grounded in reality’ and accused the party of suggesting GPs are ‘not trying hard enough’.

Following criticism from trade unions and doctors, Mr Streeting hit back, telling The Sun that the ‘something for nothing culture’ had to end.¹

Here, we take a closer look at some of his claims and promises.

‘This something for nothing culture has to end. Labour will always put patients first. We will make sure people can see a GP when they want, how they want.’

Pulse’s most recent workload survey² found GPs work 11-hour days and deal with an average of 37 patients in that time – far more than the 28 patients respondents saw as the safe daily limit. On top of seeing more patients than ever – practices in England deliver around a million appointments a day, two-thirds of which are face to face³ – and they also rolled out the biggest immunisation programme in NHS history.

Despite the soaring workload, a University of Manchester study found that income for GP partners in England decreased by 10% in real terms between 2008 and 2017.⁴ This downward trend is only just starting to change: NHS data show that in 2020/21, GP partner earnings saw their first real-terms increase for 15 years. But medical accountants say this ‘pay rise’ is only temporary, with profits projected to fall again this year.

Meanwhile, funding cuts have forced some GP practices to hand back their contracts, a notable example being Central Lakes Medical Practice in Cumbria this summer.⁵

The fact that Babylon’s digital-first GP at Hand service is to pull out of Birmingham⁶ because the venture is not ‘financially sustainable’ suggests general practice is not the goldmine some perceive it to be. Babylon now expects to ‘lose money’ on each patient, underlining that practices are certainly not receiving ‘something for nothing’.

‘Patients deserve better than a two-week wait to see a GP… When we were in government, Labour guaranteed appointments within two days.’

This statement comes from Mr Streeting’s conference speech, during which he announced his controversial GP appointment promise.

While it is undoubtedly true that general practice has deteriorated over the past 12 years, the ageing population and multimorbidity mean a 48-hour guarantee would require far more resources than it did in 2010.

There is also the question of how many patients actually need to be seen within this time frame. Urgent cases are already seen within 48 hours.

Most of all, a pledge to allow people to see a GP ‘when they want, how they want’ will require concrete solutions. Mr Streeting currently appears to have just one proposal, and even that is flawed…

‘The BMA can’t expect nothing more delivered for patients when Labour’s plan will train an extra 7,500 doctors every year.’

In another statement shared with The Sun, Mr Streeting criticised the BMA after it labelled his GP appointment promise ‘divisive’ and ‘disappointing’. However, in response, his only proposal seemed to be training more doctors. There are two main points to highlight here.

First, GP training is perhaps the only area in which the Government comes close to achieving its targets. A record 4,000 recruits were accepted to begin GP training in 2021/22, according to Health Education England, which has managed to hit the Government’s target for increased GP specialty trainee recruitment every year since 2015.

Second, while increasing medical school places is absolutely essential, it unfortunately won’t result in any newly qualified GPs for another decade and so won’t help with any pledges Mr Streeting is making. BMA GP Committee England chair Dr Farah Jameel argues that politicians should instead focus on retaining the GPs already in the workforce.

‘We urgently need a plan for retention, as well as recruitment, supporting GPs to stay in the workforce, which includes addressing unsustainable workloads and burnout, and long-term solutions to the pension tax trap that is leading doctors to retire early,’ Dr Jameel says.

‘GPs and their teams are at one with people in our communities, and both deserve better and more from the politicians that run this country.’

References
¹ Wes Streeting hits back at doctors moaning after he said all patients should get in person GP
appointment. The Sun, 29 September 2022.
² Pulse. GPs working average 11hour day, major survey reveals. 1 April 2021.
³ BMA. Labour GP appointment promise is ‘divisive’ and ‘disappointing’. 28 September 2022.
⁴ Atkins R. Trends in GP incomes in England, 2008–2017. BJGP 2020; 70(690): e64–e70.
⁵ Pulse. GP practice forced to hand back contract after ICB pulls £70k in funding. 10 August, 2022.
⁶ Pulse. Babylon GP at Hand to quit Birmingham, affecting 5k patients. 5 October 2022.