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‘Real threat’ general practice will ‘end up like dentistry’, warns RCGP chair


‘Real threat’ general practice will ‘end up like dentistry’, warns RCGP chair


There is a ‘real threat’ that general practice will face the same fate as dentistry in the UK – where a growing number of practitioners have gone private, the chair of the RCGP has warned.

Professor Martin Marshall made the comments during his keynote address at Pulse’s flagship conference, held on Monday and Tuesday this week in London.

He said that general practice being at ‘breaking point’ is ‘probably a metaphor’, but that there is a ‘very significant and very real threat’ that it could become more like UK dentistry or ‘the very worst of the US healthcare system’.

He told GPs: ‘Some practices really have struggled [and] fallen over, [but] I don’t think the model of general practice is going to disappear completely, I don’t think it’s going to break. 

‘But what I do think is if we continue under the current pressure that we’re under, general practice is going to become a more and more difficult job to do and a more and more difficult job to do well.’

He added: ‘The risk is that we might end up like the very worst of the US healthcare system where if you can pay to get good care, great, and if you can’t, you have a very sub-optimal system for picking up the pieces. 

‘Or maybe like dentistry in this country over the last 15 years, where a growing number of dentists have gone private. There is an NHS system but it is really difficult to access.

‘I don’t think we want to see that in general practice and that seems to be a very significant and very real threat that we need to address.’

The current problems being seen in general practice will continue ‘unless there is a very significant intervention and investment’, Professor Marshall said.

He set out the RCGP’s ‘vision’ of the ‘key elements of what general practice will look like in the future’.

These include :

  • Working at scale
  • Multidisciplinary working
  • Greater use of technology
  • Integration
  • Population health

Professor Marshall previously said that the QOF system for GP payments should be scrapped, as the current system ‘doesn’t make sense whatsoever’.

And last month, he said that a ‘comprehensive rescue package’ is ‘urgently needed’ for general practice in response to a report backed by the health secretary that suggested the majority of GPs should be employed by trusts.

Former health secretary Jeremy Hunt will set out his own vision for the future of the profession at the Pulse LIVE conference’s closing keynote address.

It comes as representatives attending the annual conference of UK local medical committees (LMCs) next month are set to vote on a policy to reduce core GP hours to 9am until 5pm.

READERS' COMMENTS [21]

Cameron Wilson 25 April, 2022 6:52 pm

Not difficult, impossible, to do well but don’t worry the GMC,CQC will rectify any deficit!! As just having retired I am truelly shocked at how stressfree the real world is! If HMG think that GP is worth in a year what pet insurance costs in a month then the time to consider alternative arrangements has to be on the table! Private Dentists seem to be happy enough, just saying!!

Cameron Wilson 25 April, 2022 6:59 pm

And am aware that there’s plenty of stresses in the real world that make our gripes seem insignificant, however bringing down one of the last altruistic bastions of society certainly isn’t going to help,sometimes tho you have to stop hitting your head against a wall!

Hello My name is 25 April, 2022 8:10 pm

Is there any evidence that working at scale improves efficiency, morale or patient satisfaction however? If it does not, such a move could prove the nail in the coffin. But never mind- it’s been constructed, I’m lying in it, and the lid has been placed over me. What’s a nail to me?

Slobber Dog 25 April, 2022 10:48 pm

‘Threat’?
To whom?

Beaker . 26 April, 2022 9:40 am

Surely an opportunity rather than a “threat”

Turn out The Lights 26 April, 2022 10:03 am

And moving to the dentist model is a bad thing!The patient and the establishment of not give a fig for front line GPs and the RCGP is the establishment, and doesn’t care for your 9.5 session GP and it shows.

Andrew Jackson 26 April, 2022 10:26 am

The vision:
Working at scale
Multidisciplinary working
Greater use of technology
Integration
Population health
does nothing to limit workload and make it possible to persue a long term full time career in general practice and is why the RCGP is becoming increasingly irrelevant in a collapsing system

Duncan Edwards 26 April, 2022 12:37 pm

Interesting those RCGP objectives – I’d almost be aiming for the opposite:
Not working at scale, but smaller local practices where appropriate, working together when this makes sense to them
A bit less multidisciplinary working, and instead a patient having one clinician taking proper responsibility for a problem – often a GP, but could be clinical pharmacist, hospital doctor – and less “tasks” for the GP.
Less technology looking for a problem to fix. More human interaction and technology yes when it helps us with our problems.
Less collusion of anonymity/Integration buzzwordery, more accountability for healthcare organisations like 111, outpatients, etc in sorting out their own patients without passing nonsense on to the GP practice or A&E.
Population health yes, but largely via helping individuals rather than applying impersonal audits and recalls to them as an increasing method of healthcare delivery.

I suspect Martin would agree with much of this, but the buzzwords RCGP is seeking to emphasise seem pretty depressing as a whole and more alligned with non-GP special interest groups like tech companies or the government (papering over its abject failure to provide enough doctors and nurses).

John Glasspool 26 April, 2022 12:54 pm

SHould have happened years ago

Darren Tymens 26 April, 2022 1:55 pm

Why isn’t the vision:
– high quality clinical care
– an emphasis on delivering continuity of care
– an emphasis on maintaining small-scale patient-centred general practice, bedded long-term in to the communities they serve
– collaboration at scale only when it can deliver something that individual practices can’t
– excellent terms and conditions for all staff
– making the service sustainable
– investment in proper buildings and facilities
– a clear definition of reasonable provision – with expectations matching the funding and capacity we have
People keep trying to redesign something that works extremely well. The problem with the NHS is not the way General Practice is run or delivered – it is the fact that the NHS is poorly managed centrally and regionally, and obsessed with secondary care at the expense of every other part of the system.

Patrufini Duffy 26 April, 2022 3:55 pm

And few will complain.
Google “Dentist’s near me”.
Funny how to they all average more than 4.5* on reviews, with accolades, reverence and earn a happy dollar. The NHS let them go as soon as they qualifies with BDS. And the public let them get away with that. They’ll leave you in pain, and ask you to do the metronidazole and amoxicillin rounds. The Victorian aged home visit for FREE is dead and so is free altruism. Anger is seeding everywhere and it will lead to a high wage on your head… supply and demand.
Opt out of the PCN.

Patrufini Duffy 26 April, 2022 3:57 pm

I also applaud how soft the CQC is on them. The worst oral health in Europe. A 2 page report of clean nice care. Really responsive aren’t they? Of course, never marginalised, discriminatory or profit skewed.

Doctors look at them, it is their time now to take the cake too.

Paul Attwood 26 April, 2022 5:38 pm

It is interesting to note that the majority of comments would seem to be 180 degrees at variance with the good Professor’s viewpoint. Reading the piece fills me with despondency. Perhaps I should promote such stupidity knowing that it would hasten what the author considers “a threat” which as others have noted is more an opportunity.

25 years ago GP-UK, a mainly defunct email forum, discussed an NHS (Lite) safety net and a more payment based system otherwise. We are almost at that threshold.

This can happen by slow change as GPs leave and the system breaks down or perhaps politicians could recognise where we are and start a Royal Commission to discuss what could replace the NHS with the only proviso being that the status quo is non viable.

Any chance do you think with the calibre of those in parliament being what it is? I despair.

Patrufini Duffy 26 April, 2022 7:05 pm

If only Processor Steve Field and Arvind Madan and Processor Stokes Lampard all had an opinion of that era of Working At Scale and a horrific decimation of Primary Care and CQC led guttering of the profession. They all ran away. Well orchestrated. How interesting.

Dave Haddock 27 April, 2022 7:09 am

The RCGP have done more than enough damage already thank you Prof.
Dentists that have left the he NHS are happy at work and able to give decent care to their clients.
What threat?

Nicholas Sharvill 27 April, 2022 7:52 am

Pulse has often had a very moral sapping editorial slant with a self selective readership.
Some of those high up in medical politics have personal agendas and maybe personal financial interests in econsult., Mega practices practices etc
At ground level dare I suggest there are partners drawing a ‘full share’ but working less than full share and not investing in others to do the work then taking on extra fee paying activities but also upset at the work it is associated with
There are many though trying to provide a good safe service who are not represented well and nhse seem intent on destroying this,.
The RCGP maybe at last realising they need to speak up to preserve what many want to stay and not end up like dentists and vets .

Patrufini Duffy 27 April, 2022 3:30 pm

That is certainly true Nicholas.

Patrufini Duffy 28 April, 2022 3:21 pm

The GP Apps are what Dentists are. Discriminatory based on wealth and problem. Selective bunch. Different rule book, same public, maximal glamour. Questionable intention and evidence base. Easier to remove your tooth than fix it. Perhaps that’s a
attractive model? What does a Dentist do, when the person doesn’t turn up to an appointment, then thinks they can complain, and have another on the same day, or go to the Ombudsman. And the institutes side with the public. Doesn’t really happen does it. The dentist says see me privately on Saturday I’m free then if you want or go elsewhere. I love my Dentist. They’re the best 5*/£500.

Dave Haddock 29 April, 2022 4:07 pm

We wouldn’t want GPs in control of their own workload, with time to do the job properly, working only the hours they choose to work, seeing only the patients they choose to see, free from the control of the NHS. Oh no, that would be terrible.

Jamal Hussain 1 May, 2022 9:37 am

UK dentists seem pretty happy. I know several.
GPs are dumped on. The model of a global sum with no restraint on dumping from secondary care and no correction for an ever increasing workload and increased complexity is bullshit. Especially with the ever increasing numbers of patients taking their doctors to court. Muddling through and doing one’s best given the situation is not a good move. When you are getting sued in 10 years no one will give a ….
It’s time to provide good medical care to the number of patients that one can safely and appropriately provide care to in a day. If private practice is the way to go then what is wrong with that. We don’t work for the Red Cross or MSF. If there aren’t enough doctors or nurses then that is a problem for the government not for the individual doctor or nurse. If the government wanted to fix it they could. It all comes down to improving pay and conditions. If they don’t want to do that they can call in the Red Cross and MSF.