Lack of GP retention strategy plagues recovery plan

Rhiannon Jenkins analyses the Government’s plans to build capacity with non-GP staff and new GP training places

In the recovery plan for general practice, the Government has pledged to ‘tackle the 8am rush’ by building capacity so practices can offer ‘more appointments from more staff than ever before’.

One way in which it aims to do this is by making available an extra £385m in 2023/24 to employ 26,000 more direct patient care staff. But this is not a new plan – the ambitious target was introduced in the 2019 contract, and the number of direct patient care staff has indeed increased since then, via the additional roles reimbursement scheme (ARRS). The plan claims that staff numbers are now 44% higher than in March 2019.

Additional staff doesn’t necessarily translate to capacity

But as Ben Gowland, director of Ockham Healthcare and former NHS executive, points out, this does not necessarily mean that additional capacity has been provided.

‘Of the 34,700 additional staff that are delivering patient care, 32,200 are ARRS or administrative staff,’ he says. However, they can’t provide the same capacity as traditional GP staff.

‘While people like social prescribers see a lot of appointments, it’s basically new demand. Overall more patients are being seen, but it’s not really true that the capacity from the ARRS staff is the same as that of practice staff.’

Furthermore, the plan’s claimed number of additional GPs – an extra 2,200 – includes both GPs and doctors in GP training. In reality, the number of fully-qualified GPs has gone down. In response to the lack of a plan for boosting GP numbers, shadow health secretary Wes Streeting called the plan ‘a shallow offer’ and poignantly pointed out that ‘better hold music isn’t going to change that’.

Hiring non-GP staff seems to be the Government’s silver bullet solution, but the Government also announced that it will further expand GP specialty training. While it has done well to increase GP specialty training numbers from 2,671 in 2014 to over 4,000 today, training fully qualified GPs takes time. The plan acknowledges this and outlines that ‘ambitious’ proposals will be set out in the still-to-be-published NHS workforce plan, which will likely include alternative routes into medicine as PA Media reported that up to one-in-10 doctors could receive on-the-job training in the coming years.

International medical graduates

Meanwhile, international medical graduates (IMGs) will be granted a four-month visa extension after completing GP specialty training from autumn 2023. In the plan, NHS England said that ‘over half of doctors’ in GP training are IMGs, but due to the three-year length of GP training these doctors ‘are typically not eligible for indefinite leave to remain’, which requires at least five years working in the UK under the skilled worker visa.

The BMA wrote to immigration minister Robert Jenrick earlier this year calling for a six-month ‘grace period’ for IMG GP trainees, which would ‘help alleviate some of the stress and anxiety’ experienced at the end of their specialty training. Although the proposed visa extension is two months short of the BMA’s proposal, it is arguably a step in the right direction.

GP retention

Finally, in terms of retaining experienced GPs, the Government announced that it will encourage them to stay in practice through the pension reforms announced by Chancellor Jeremy Hunt in the Spring Budget, which included the removal of the pensions Lifetime Allowance and increasing the Annual Allowance from £40,000 to £60,000.

However, Andrew Pow, board member of the Association of Independent Specialist Medical Accountants, said that ‘retaining GPs is not simply about pension issues, which were partially addressed in the Spring Budget’.

Mr Pow added: ‘The significant problem currently impacting practices is cost inflation. The contract imposition means that practices will not see their income uplifted anywhere near the levels to cover cost increases – particularly staff costs and energy increases.

‘Failure to deal with this in the recovery plan will lead to further problems in 2023/24 for practices. Access to primary care needs people, and without investment in people at practice level, it is difficult to see how access will be improved in areas that are struggling.’