Rachel Carter looks at the impact of sky-high inflation on patients’ health and on GP practices
‘A lot of our patients live in fairly suboptimal housing; many have had mould or damp issues for a long time, and this crisis seems to be making things worse,’ says Dr Paul Evans, chair of Gateshead and South Tyneside LMC. ‘People mention that they are just not turning the heating on now because they are terrified of the bills they will get if they do. If we’re talking about someone who is immunosuppressed or has a respiratory condition, that’s really not going to help them at all.’
Ahead of winter 2022, GPs issued stark warnings over what the cost-of-living crisis would mean for the health of their patients. Now, research by Pulse has revealed that many are seeing more people present with problems caused or exacerbated by the rising costs.
Patients’ physical health and wellbeing is affected by having to survive on cheaper, less healthy food, and by their living conditions when they have to sacrifice heating. The associated worries also have a mental health impact.
At the same time, practices themselves are not immune to the pressures and are also having to find ways to make ends meet. In some cases they are taking drastic action, such as reducing energy use or even making redundancies.
Impact on patients
The results of Pulse’s November7 survey are shocking. The poll of 1,000 GPs revealed that, on average, 22% of consultations were caused or exacerbated by the cost-of-living crisis.
The effect on mental health is one of the biggest problems. One respondent commented: ‘Many mental health cases include financial and social strain as part of the aggravating factors.’ Another said: ‘There has been an increase in all consultations due to mental health, both new and worsening. Cost of living may not be specifically mentioned but is definitely one of the stressors driving this.’
Dr Evans agrees that his patient group is collectively more ‘stressed, unhappy and fatigued’, with particular consequences for patients with long-term conditions. Those with diabetes, for example, are badly affected: ‘When money is tight you buy what’s cheap and that predominantly means carbs, so for a lot of our diabetic patients, type 2 particularly, their HbA1c levels are going up and up and up, which obviously is going to have an impact on their risks for things like heart attacks and strokes.’
Patients, especially those who are older or more vulnerable, are at additional risk if they cannot afford adequate heating. GP partner in Nottingham Dr Irfan Malik says: ‘I actually had to sort out a boiler for one vulnerable family who had been living without one for a few years. Kindly, a charity helped out and funded a free boiler.’
GPs are finding themselves doing more signposting to other agencies and referring to foodbanks – and some have considered broadening their offer of support beyond the strictly medical. Pulse’s survey found 16% of 469 GPs were implementing initiatives to help their patients. Examples given included actively contacting vulnerable patients to offer support, making more use of social prescribers, and working with local agencies to provide a warm space and hot meals. GPs also revealed they were allowing patients to access their waiting rooms for longer to keep warm.
In September, Pulse reported on how the Project Surgery in Newham, east London was repurposing its meeting room as a ‘safe space’ for local people to drop in to get warm and have some soup over the winter months. GP partner Dr Farzana Hussain commented at the time that she wanted it to be a ‘non-judgemental, safe space’, adding that she was scared about the risks of elderly patients dying
Meanwhile, in Gloucestershire a ‘Warm Home Prescription Scheme’ for patients with cold-sensitive health conditions was launched in November 2022, allowing GPs and other healthcare professionals to prescribe a heating plan to support patients at risk, under which the patients have their bills paid.
Practices struggle with rising costs
Practices are also feeling the pinch. Pulse’s survey found one in five of the 469 partners polled is asking staff to wear more layers instead of turning up the heating, and around 40% said they are reducing energy use. Some partners were also dropping sessions and pausing recruitment to cut costs.
In August last year, Pulse reported that practices could face losses of tens of thousands of pounds due to rising inflation, with specialist GP accountants predicting the pressures could even force some to hand back their contracts. North Lincolnshire GP partner Dr Gary Armstrong told Pulse at the time that his 15,000-patient practice was looking at a £50,000 increase in costs – before even looking at the pressure on wages – due to the rising prices of energy and consumable items.
A month later, the Government did pledge some support for businesses – including GP practices – capping their energy prices at ‘less than half’ of wholesale prices over the winter of 2022. But this support only runs until March this year, after which business have only been promised a discount on wholesale prices, rather than costs being capped, under the latest Government plans.
Specialist medical accountant Andy Pow tells Pulse that practices are facing a number of rising costs that, when added together, become ‘a big problem’. On energy costs alone, a survey carried out by the Association of Independent Specialist Medical Accountants, of which Mr Pow is a board member, found 59% of accountants thought the energy costs of their GP practice clients would go up by 10%. Another issue he is seeing is a fall in drug profitability; where GPs may have previously made profits, they are now having to purchase drugs at a higher price than they are reimbursed for. It’s been a huge problem in pharmacies for some time, but now he warns that it’s ‘knocking into the GP side as well’.
But he adds that while energy prices ‘aren’t great’, they represent around 3-4% of overall practice costs. The much bigger hit is the wage bill, he says, which accounts for around 60-70%. The Review Body on Doctors’ and Dentists’ Remuneration (DDRB) recommended a 4.5% salary increase for staff, including salaried doctors. But GP partners remain locked into the existing five-year agreement which gives them just a 2% year-on-year pay rise and the Government refused to adjust practice funding to help them meet the DDRB recommendation.
Only around half of partners responding to Pulse’s survey said they were able to award these pay rises. Liverpool LMC medical secretary Dr Rob Barnett says: ‘Where practices have funded it, this has come at a cost to partners and it is partners that have invariably taken the hit.
‘So, they have done their best to keep things going… but we have seen situations where struggling practices have started to wonder whether they should continue providing services at all.’
- ONS. Cost of living insights: Energy. January 2023. Link
- CNBC. UK inflation hits 41-year high of 11.1% as food and energy prices continue to soar. November 16, 2022. Link
- Resolution Foundation. One statement, two challenges. 15 November 2022. Link
- University of York. More than three-quarters of UK households to be in fuel poverty by the new year, according to new report. 8 August 2022. Link
- The Trussell Trust. Mid-year stats, April-Sept 2022. Link
- Asthma + Lung UK. Cost of living crisis: 1 in 5 people with asthma surveyed say price hikes causing asthma attacks. 28 September 2022. Link
- Pulse. More than one in five GP consultations caused or exacerbated by cost-of-living crisis. January 2023. Link