Exclusive General practice has suddenly gone from a recruitment to an employment crisis, driven by the Government’s squeeze of practice finances, BMA England’s GP Committee chair has warned.
Dr Katie Bramall-Stainer told Pulse that the crisis seems to have escalated ‘in a very quick timeframe’, going from ‘a narrative and discussions about the paucity of GPs’ and recruitment issues to thousands of GPs ‘allegedly’ out of employment.
When asked by Pulse if general practice is going from a recruitment crisis into an employment crisis, she said: ‘I think we are in it’.
‘Suddenly here we are in January 2024 and we allegedly have thousands of GPs who have recently CCTed and completed their training who are unemployed. We’ve seen the messages play out across GP social media around well-founded concerns of younger colleagues being frozen out of practice-employed roles and locum roles.
‘You would always see a slight bulge in those GPs that have completed their training in the August to January window. But we are going to lose those GPs from the profession that we’ve trained, because practice can’t afford to employ them.’
Recently a Pulse survey of 612 GP partners revealed that there has been a 44% reduction in the number of GP vacancies advertised since the same month in 2022 and GP leaders attributed this reduction in vacancies to a number of factors, including an increase in the ARRS success in hiring staff and a lack of resources.
And this week a practice in Surrey said it is making three GPs redundant due to ‘new ways of working’, including the use of ARRS staff, and virtual rather than physical consultations.
‘Some practices are being are being forced into choosing subsidised roles because their funding has been squeezed so much now,’ said Dr Bramall-Stainer.
‘It’s a very difficult narrative for the public to understand, let alone for members of our own branch of practice to appreciate the reasons for and even other branches of practice look in absolute bewilderment and puzzlement as to why we’re in this situation.’
But she said that although ‘there was an awful lot of noise over additional roles’, the culprit for the crisis is ‘actually multifactorial’.
The major problem is how practices have been financially squeezed by the Government, she argued. This week, she revealed that initial findings from a BMA survey of practices found that GP contractor income in England has dropped by a fifth in the past year.
As a result, the NHS is ‘going to lose those GPs’ because ‘practices can’t afford to employ them’, she said.
‘I think we’ve got a perfect storm but at the eye of the storm is the unarguable fact that practice funding has been squeezed to such a degree that 54% of our respondents to our practice final survey have reported a reduction in partner drawings and the average pay cuts for those partners is more than a fifth.’
Dr Bramall-Stainer warned that general practice is now in a ‘really precarious place’.
‘And you wonder if from a Department of Health and NHS England perspective, that they have intended to go this far, in terms of pushing contractors and squeezing income at practice level. Where’s the benefit in this? Because the evidence base for expert generalism and for continuity of care is embarrassingly well made.
‘So I don’t understand the reasoning behind it. And I’m really struggling because, surely, it’s not about destroying primary care. Because if you destroy a primary care, you destroy the NHS, so I that surely can’t be their modus operandi. Or can it? I think we can see the answer.’
Dr Simon Abrams, a GP and chair of Urgent Health UK, also told Pulse: ‘A good proportion of my colleagues are reporting that they’ve found it easier to fill their shifts because of this swing that’s happened [towards GPs struggling to find work at practices] which I’m fully aware of. What I’ve heard is that our OOH providers are now just finding it easier to fill their shifts.
‘We monitor workforce issues and for the majority of the last 20 years it’s been hard or very hard to fill shifts. It’s varied over different times. But this is the first time where it looks as though it’s getting easier to fill shifts.’
‘There seem to be more GPs looking for shifts now.’
Yesterday Pulse revealed exclusively that a Government offer for the next GP contract will be put out to referendum by the BMA next month.
READERS' COMMENTS [17]
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Sorry but its pretty obvious to me HMG has weaponised against the one sector it has made a calculated risk it can do GPs
Don’t take ARRS and you financially disadvantage your self and lose some help at the front line
Squeeze finances and weaponize access and hey presto GPs are looking for work in some areas
Once unattractive OOH shifts filled another win win for HMG
Contract enforcement and suddenly we delivered for the tory party and in spades for very little money
You asked we delivered millions more appointments they cry
Going to take some deft work by GPC and colleagues if the present lot get re elected to turn this around
Labours Les Streeting seems side tracked with Darzi and a salaried service
Where are all these unemployed GPs? In rural practices we have struggled to recruit GPs for years and still have open adverts for GPs on competitive salary, lovely place to work and lovely patient group but still no applicants. We are having to employ nurses and paramedics ourselves (not through ARRS) just to see the patients. We still want and need GPs.
It reminds me of 2005 -6 crisis for new graduates to find hospital training posts. Lots of doctors immigrated to Canada or Australia . Same thing will happen again. Gp funding may be at the root of it. Bring back open and designated area to fill the gap. In 1980s I had same problem and started practice in open area successfully.
Look at your location. Rural and out of the way places are obviously not going to get many applicants. The cities have no GP vacancies whatsoever – Manchester, Birmingham, Leeds, Bradford etc.
Solution is simple. Have private practice running in the same site as the NHS practice. Run the NHS practice down and run it with mostly ARRS. People will migrate to the private side to see a GP and you don’t have to risk losing your GMS contract while doing it. Things how the dentists did it. I am not agreeing with it but I think those minded to do this now have a risk free way out.
This is happening already…
I agree with Katie Ramsey there are lovely rural GP surgeries and good patient populations which can give better working life than city based practices. Location may just not work with younger GPs at that point in their professional life. As a first 5 GP and talking with my peers lots to worry about at the minute looking at 20 plus years of working life in the future. Most of my peers now looking at different options and ways out of general practice as it’s become uncertain about job availability and may be worse in the future, and also the role we may be expected/forced into which may not be the one we trained for. I’ve worked in Australia for 5 years prior to returning to UK for Gp training. I’d be back there tomorrow but have a young family so not right for us at the minute. Foundation doctors I’m supervising or GP trainees at least for the past year have been making the same comments that they are worried about what their career will be in the NHS. Sadly many of them are exploring tech and pharmacy sector or consulting. I have had friends at consultant level surgeons who have left now due to NHS but are no thriving in private sector in different roles. We shall see what befalls the NHS in next 5 to 7 years but things likely to get worse. Who knows but for GP if keep getting squeezed out a parallel private and public service may be what saves it from either crumbling completely or going the way of our friends across the Atlantic.
We need a rethink about the feasibility of the NHS going forward ASAP before we lose all our medical staff for good. Why on earth are we trying to protect a system that gives such rubbish results. I was in A+E with a septic young adult kid of mine before the doctors strike last week and it was carnage – she could barely sit up but never made it to even a trolley and despite being told they wanted to admit her there were no beds whatsoever. We were in a cubicle with 6 other people sitting on chairs and she had to lean on me to avoid falling onto the floor. It’s a total shambles and I wish to God someone would put this terrible system out of it’s misery!
There certainly seems to be a crisis in locum GP employment opportunities.
But is there a crisis in salaried and partner employment? Are there GPs out there looking for salaried / partner posts unable to find them? Or have practices just stopped advertising for these positions due to lack of interest?
I’d be interested to hear below from GPs struggling to find salaried / partner positions.
Primary care is not in this terminal state because of the actions of salaried GPs or locums (who are paying a hefty price, newly qualifieds can’t get a job!! ). It has been the bourgeoisie of labour and tory MPs, NHS management and those GP principals (usually found sitting in committees rather than seeing patients) that have been first in the queue to help deliver the situation we are now in, and that our patients now have to suffer. The politico-medico–managerial complex.
I don’t think the British public will go for a “dentist” type model of healthcare and nor will private general practice be financially viable. It’s clear the NHS will continue to be free at point of delivery and that all GP principals will become salaried very soon. No schadenfreude from me.
In this city, there are around 60 principals (with voting rights, who’ve presided over the local decline over the last 10-15 years), 60 salaried and around 100 locums desperate for work and earning little. But the principals’ earnings are excellent and between £120k to £250k. Go figure.
Why would a Practice take on more GPs?
The NHS rewards Practices that see as few patients as possible, It’s mad.
On the upside, the worse the NHS patient experience gets, the more opportunities for Private Practice and escape from the ghastly monstrosity of the NHS.
The selfish nature of proponents of private practice are increasingly apparent and in your face. Those pushing for the ‘dentistry model’ simply don’t care about the evidence showing that what has resulted is the development of our children in England with caries as the leading cause of hospital admission. This is what ‘Dave Haddock’ and other similar voices clearly want. The artificially constrained GP pool will inevitably first opt for OOH before slowly segueing towards well-marketed private practice – hey presto (“but it’s not privatisation”)!
It’s difficult to escape the conclusion – echoed eloquently by Prof Sir Michael Marmot as a postulate hypothesis – that the running down of the NHS model can be viewed as the purpose, rather than as happenstance, of privatisation by political choices over decades.
It’s impossible to conclude that the simultaneous loss of recruitment and its restriction of GP employment is accidental. The political replacement of GPs by PAs is part of this deliberate dumbing down of medical care to two-tier second-rate (sorry PAs) NHS provision. It wasn’t an accident that felt it necessary to change the title of ‘assistant’ to ‘associate’; blurring the titles, roles and boundaries of medical practice. It’s no accident that DHSC/NHSE are actively promoting PAs with huge salaries, paid for by NHSE, whilst GPs are deliberately excluded from recruiting GPs into practice and simultaneously experiencing a drop of 20% of their contracted income. It’s no accident that Babylon, Centene, and Palantir popped into being as the new nirvana.
The hammering taken by ‘Junior’ Doctors and GPs is meant to render your worth fruitless and helpless. This shitshow can be traced back to the advocates of Tory policy enabled by ‘global health’. Darzi it not the answer: he is part of the problem. The obvious remedy is obvious (and repeatedly stated in authoritative reports): beds, workforce, resources. The mindless repetition that we can’t afford the NHS is only countered by the actual evidence base that, actually, we can’t afford *not* to fund the NHS. Stop believing tossers and lobby instead for patients – not lobbyists for NHSE, DHSC/industry and their ilk.
It is taboo and uncomfortable to admit but as highlighted already, it is in my view a small group and percentage of GPs in every area I would think but certainly ours who maybe PCN Clinical Directors, sit on CCG (now ICB boards), Clinical Leads , small percentages of LMC members who have been gaming and continue to game the system for their own personal and financial gains.
They have acquired knowledge and information about changes/contracts at an early stage and used this not for the benefit of the wider GP community who they are paid to serve but to feather their own nest or for personal financial gain.
In our area there are some very dedicated admirable leaders, and, in my view, they constitute only about 5% of these roles and are very much the minority.
These groups have considerable influence in these areas, and it has been used in many (not all) cases for personal advantage.
It is of course true that the root causes are multifactorial, but these negative influences have been enabled by these self-serving small groups in positions of influence allowing other subsequently introduced negative polices to take root in a system increasingly in disarray.
There is unquestionably a reduction in overall GP practice income but PCNs and PCN Clinical Directors are directly responsible for the increasing influence of lower qualified ARR staff who absolutely have their place but too often are used to inappropriately replace GPs which is not their place. They are also in some cases inefficient with vast numbers of prolonged or repeat consultations and at salaries of £35,000 to £70,000(variable) with lower consulting rates are not cheap but enforced by the government with PCN Clinical Directors and PCNs acting on their behalf forcing Primary care into the abyss. This could unsuitable role allocation have been resisted rather than enabled.
Even GP social enterprise or community interest setups state they are non-profit making, but deeper enquiry demonstrates vast sums are being paid to the managers and directors disguised in my opinion under these arrangements.
Locums are not without fault as in our practice we always prioritise the use of locums over cheaper non-GP ARRs filling GP roles where available and have rarely paid If ever paid below £95 to £100 per hour. Pharmacists have been of value as they are reimbursed and are specifically trained in their role although in many cases a GP would do the same work in a quarter to a fifth of the time so they are not cost effective as generally stated but this is in reality where other professionals are in fact required to fill the staffing gaps and comply with ever increasing but increasingly useless regulation.
Recently we had a locum cancel at relatively short notice (rate over £100 per hour ) as we believe they were offered more sessions at another site so locums are not without blame and we experienced this scenario frequently in past years.
The crux of the problem in my opinion lies in the same self-serving failing leaders and names jumping into local leadership roles (can each area relate to this?) with no intention of serving Primary Care but simply lining their own pockets, gaining funds or contracts for their own practices or for personal awards as has happened for decades and until this distasteful fact is recognised and change ensues, then the decline of General practice will continue unabated.
I am dying to work in a GP surgery but RCGP isn’t allowing me to, because I have failed the CSA by 5 points. Not only this, but I am not even allowed to re-apply for training.
I have trained for 4.5 years full time, on a 4 year
placement and discharged from training in 2015 for the reason I described. Meanwhile, PAs,
paramedics and pharmacists are of course allowed to work in a surgery. I think that says it
all! Oh wait! We have been in meetings with the RCGP chair over the years, last time we were
bluntly told simply no chance to even consider bringing doctors like us back to general practice. Even though the chair did also say this isn’t right of course. Politics in every organisation seems always more important than the nation’s needs somehow.
Ignore my previous comment. It has been sent erroneously.
Liliana, these thing need to be said.
I am very sorry to hear about the bizarre way you have been treated.
And I hope you have found a career outside medicine, where you and your skills are appreciated.
I’ll second the last commenter. Thanks for sharing. Sounds like you’ve been subjected to the Kafkaesque workings of the jobsworth medical bureaucrats. Best wishes.