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Rising pressures push GPs to cut clinical services as demand rises

GP partners have been forced to implement drastic measures to cope with ongoing pressures as patient demand rises, new research has shown. 

A Pulse survey of more than 2,000 GPs and other primary care staff found that 41% of GP partners considered discontinuing services or actually implemented service cuts over the past year.

The findings also revealed 29% were forced to cut the number of routine appointments while 24% either went ahead with or thought about closing their lists temporarily.

GP leaders said the figures are not surprising as GPs currently work ‘beyond capacity’ and are ‘unable to cope’ with increasing demand, and called for all funding allocated for general practice to make it through to frontline services, ‘rather than being tied-up in red tape’.

The report, released today by Cogora – the company which publishes Pulse and sister titles including Healthcare Leader, The Pharmacist, Nursing in Practice and Management in Practice – is the sixth annual analysis of the state of primary care.

It looked at attitudes and trends among Pulse and sister publication audience regarding issues such as staffing, rising workload and low morale.

Among the 549 GP partners who responded to the survey, a staggering 41% said they either had to discontinue or considered discontinuing clinical services in 2018. 

The survey also reported 29% of GP partners had to cut down their number of routine appointments, due to intensifying pressures, while 24% either closed their patient list temporarily or thought about doing so. 

Doncaster LMC chief executive officer Dr Dean Eggitt said: ‘I’m unsurprised by the results of the survey showing that almost a half of GP partners considered discontinuing clinical services or implemented service cuts.

’General practice is beyond crisis point and is in the process of shutdown. We have burnt out the foundation of the NHS and UK healthcare is in the process of crumbling.’

‘Patients complain of poor access to care or go without altogether because we are beyond capacity and are unable to cope. 

‘Current efforts seem to be spent trying to figure out how to cope rather than how to thrive or how to grow. In my opinion, we are witnessing the slow death of general practice as we know it and I do not know what will rise from the ashes,’ he added.

Londonwide LMCs deputy chief executive Dr Lisa Harrod-Rothwell said the figures reflect the state of many practices in London, which have no choice but turn to the LMC for support. 

She said: ‘It is worrying to see so many practices reducing appointments and considering limiting other services, this is not only bad for GPs and practice teams, but for the patients who rely on accessible primary care services close to their homes. GPs do not take these measures lightly, but they need to ensure they can practice safely within the workforce and resource limits they face.

‘These statistics echo our experience of supporting GPs and practices in London. Many come to us for help with workforce shortages, mass registrations after list dispersals and funding being removed from enhanced services. It is vital that all finance earmarked for general practice makes it through to frontline services, rather than being tied-up in red tape, as so often has been the case in the past.’

North Wales LMC chair Dr Sara Bodey said: ‘The numbers are not at all surprising. Practices are under both financial and workforce stress.

‘Many enhanced services barely cover the cost of providing the service and with pressure on finances and staffing practices are having to look at everything they do over and above core contract to decide if it is something worth continuing.

‘Splitting appointments into urgent and routine is in many ways a bit artificial, but again the political focus is on dealing with the on-the-day demand and this is going up. There is only so much a clinician can safely do in a working day and so there is an inevitability that more on the day work – and fewer clinicians – translates into less time for other things, whether routine or enhanced services.’

She added: ‘List closures are the only real option a practice has for controlling its list size, so yes practices are looking at that, particularly when they have severe workforce problems. However the process to achieve this is fairly long winded and so some don’t pursue it.’

A previous Pulse survey revealed one in six GPs had to stop routing bookings, limiting appointments to ’emergency’ patients only

The survey was open from 29 November to 20 December 2018 inclusive. Cogora offered all respondents the chance to win a £250 John Lewis voucher as an incentive to complete the survey. Cogora invited people to complete the survey through newsletters sent directly to each publication’s readers, and by way of advertisements on the publications’ website home pages. It was also promoted through the publications’ social media channels. There were 2,885 responses in total.