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.’