The warning lights have been flashing bright red for years, but the NHS is only just taking action to address the crisis in the GP workforce.
NHS England has published a £10m strategy to tempt medical graduates to become GPs and experienced GPs to delay retirement.
The ideas include ‘golden handshake’ deals for GP trainees if they work for three years in areas with a shortage of GPs, and incentives for older GPs to stay in practice.
There will be a new national scheme for returners, and cash inducements if they also agree to work in an under-doctored area.
GP leaders have cautiously welcomed the new plan, but warned that it is dwarfed by the scale of the challenge.
Last year, Pulse revealed that practices in some areas were waiting a year to fill a partnership vacancy. Some areas were having to cope with one GP to every 8,000 patients and even those in more prosperous areas were struggling to recruit.
What is a ‘golden handshake’?
‘Golden handshakes’ are financial incentives used to attract staff above and beyond standard pay. They normally come with conditions attached, such as a particular length of service. GP practices, CCGs and Health Education England have started using them in areas of particularly poor GP recruitment. The Department of Health introduced a ‘Golden Hello Scheme’ for GPs in 2001, with the same intentions. It was dropped in 2005.
And there is little sign of their imminent replacement by newly trained GPs; last year, 12% of GP training places remained unfilled, despite Health Education England running an unprecedented third round of recruitment.
An internal briefing paper from the GPC – revealed by Pulse last year – said the effects of the workforce crisis could ultimately be ‘catastrophic’ for general practice. And this seems to have spurred NHS England to throw money at the problem.
GPC education and training subcommittee chair Dr Krishna Kasaraneni says he is ‘tentatively’ positive about the plan, but adds that the profession needs to see the promises translated into actions on the ground.
He says: ‘A few years ago, policymakers and NHS managers had their heads buried deep in the sand, denying there was any crisis in general practice and particularly with the workforce.
‘A shift has taken place in the past 12 months. You can’t move at the moment in the media for promises of more funding for GP services, and policymakers are constantly chattering about the problems facing GP practices.’
But Dr Kasaraneni warns the current strategy is not enough: ‘Wider GP services are continuing to struggle and politicians of all parties have still not realised that they cannot keep bombarding voters with promises that are undeliverable, whether it be 48-hour targets for GP appointments or extensive, longer opening hours for practices.’
It resolves to attract medical graduates to the profession with a national marketing campaign extolling the virtues of general practice. The RCGP has already released a video claiming ‘this is the best time in a generation to become a GP’ and has begun holding a series of 16 roadshows with HEE to encourage more medical students and foundation doctors to choose general practice.
GP trainees will also be offered the opportunity to spend an extra year outside general practice after training – for example taking an MBA or working in emergency medicine – and financial incentives to work for three years in an under-doctored area.
This is a welcome move as there are no signs that this year’s recruitment drive for GP training places will be any easier than last year’s.
The GPC told Pulse before Christmas that fewer than 40 graduates had applied for 148 GP training places in the North-East of England this year – although HEE says it ‘does not recognise’ the figures.
But ‘golden handshakes’ are not a new idea. The Department of Health’s ‘Golden Hello Scheme’ was introduced in 2001, and closed in 2005 because the incentive was no longer seen as necessary for GPs under the new contract.
And there are doubts over whether they will work this time round.
In Doncaster, the Thorne Moor Medical Practice offered a £20,000 ‘golden handshake’ to recruit a new GP partner to stay at their practice for three years or longer last summer, having spent a year failing to find a partner.
But Dr Dean Eggitt, medical secretary of Doncaster LMC, says it took several months for people to start applying, and although the practice ended up finding a ‘very good candidate’, he doubted whether it would work nationally.
He says: ‘The difficulty is that we don’t have an abundance of doctors. If you have 10 spare doctors, and 20 practices need them, if you give everyone the opportunity of the golden hello, you have simply recreated the status quo.’
HEE also recently put up £400,000 to fund golden hellos worth £10,000 for practices across Essex, but Dr Brian Balmer, chief executive of Essex LMCs and a GPC negotiator, says it is too early to tell whether or not the local scheme is likely to be successful.
He adds: ‘It is being extended to more CCGs than it was, but it hasn’t been going long enough to know how good it is going to be.’
Elsewhere, NHS Hull CCG promised to find overseas placements for trainees and qualified GPs, and said it would fund MBA or a Masters degrees in education or leadership and will give GPs the opportunity to work in different practices to make the package as ‘attractive’ as possible.
But there were rumours that the deadline for applications had to be extended because of a lack of interest and, five months after it was set up, the CCG has admitted to Pulse that it is ‘still in the process of recruiting to the scheme’.
NHS England also has ideas to tackle the retirement ‘leaky bucket’ and encourage older GPs to stay practising. It says it would look at offering experienced GPs the opportunity of portfolio careers or heading up mentorship programmes.
There will be a review of retention schemes and a new national programme to make it easier for GPs to return to practice, potentially offering financial incentives to work in under-doctored areas.
NHS England ‘will make available additional investment to attract GPs back into practice, increasing over time’, with resources given to practices to help with the cost of employing these staff.
There are also plans to recruit new grades of staff – such as physicians’ assistants – to help take the pressure off GPs. These non-medically trained staff will take medical histories, perform examinations, diagnose illnesses, analyse test results and develop management plans.
But practising GPs to whom Pulse has spoken to are less than impressed.
Dr Peter Holden, who was a GPC negotiator for 15 years until last year, says: ‘When a boat is sinking, stick your finger in the hole first, don’t try to pump the water out.
‘We will have gone by the time they have reviewed the retention schemes. What is immediately needed is a reversal on the seniority system, so we keep [the payments] in full until we retire. That is the way to keep us in. Otherwise, there is no incentive to stay.’
Dr Gaurav Tewary, a GP in Wollongong, New South Wales, Australia, who moved from Coventry last year, says the package of measures would not be enough to tempt him to return to the UK.
Dr Tewary says: ‘This is simply saying “we’ll give you some more money”. That’s not why I left. I probably earn less here. I would like to see changes to the things I didn’t like before I left.
‘Removing political interference would be the first thing that could tempt me to come back. We have lost our independence.’
So the plan may not be enough to provide a quick fix for the GP workforce, as the real problems are much wider.
As Dr Eggitt bluntly puts it: ‘What we really need is stability and long-term investment. We don’t want one-off election pledges. If you are just going to give me a one-off, keep the bloody money, I don’t want it.’
What does the 10-point plan include?
1. A marketing campaign for general practice careers, including a letter to all newly qualified doctors
2. An additional year of training to study a special interest in medicine or business for GP trainees
3. ‘Training hubs’ for GP practice staff to extend their skills
4. ’Golden hello’ incentives for GP trainees committing to work in an under-doctored area for at least three years
5. A review of retainer schemes and investment in a new national scheme
6 New premises funding for training practices
7. Incentives for experienced GPs to remain in practice, such as a funded mentorship scheme or portfolio careers
8. Pilots of new support staff to take workload off GPs, such as physician associates, medical assistants, clinical pharmacists and advanced practitioners
9. Clearer induction and returner scheme for those who have worked overseas or taken a career break
10. Financial incentives for returners opting to work in under-doctored areas and reviewing the value of the performers list
Source: NHS England, Jan 2015 Building the workforce – the new deal for general practice.