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NHS England ‘almost burying head in the sand’ on GP workforce crisis, admits director

The deputy medical director for NHS England, Dr Mike Bewick, has admitted that they are ‘burying their heads in the sand’ on the GP workforce crisis.

Speaking at an NHS England ‘Call to Action’ event organised by Newham CCG and the London area team, Dr Bewick said the GP workforce problem was probably ‘the most pressing issue’ the NHS faced at the moment, but refused to link the problem to any erosion of pay.

It comes as NHS England last week rebutted calls for GPs to be given a pay rise above 1%, stating that there are ‘no compelling issues’ with recruitment in supplementary evidence to the GP pay review body, which had previously pointed out that there were problems with recruitment of salaried GPs in many parts of the country.

Answering questions from the floor at the NHS England event, Dr Bewick said there were ‘three elements’ of the GP workforce issue: ‘I think it one of the most pressing problems that we probably have and we are almost burying our heads in the sand. I think there are three elements of this… we are certainly not training enough, and I don’t think we are training enough that are going to be working full time.’

‘The second is about retention and we have got to do something to ease the burden. With the contract changes, one of the elements that we tried to pick up on was to reduce the burden and give headroom. It is a small token but I hope to keep you signposted on where we are going, into more broader outcomes rather than specific, granular outcomes, which will take away the burden.’

He also pointed to difficulties returning GPs, which is a priority of the new RCGP chair, Dr Maureen Baker.

Dr Bewick added: ‘Third, it is about bringing back people into the workforce, making it easier for people to return. We are looking at methods to do that.’

He also reiterated that NHS England intends to ensure that the right people become GPs, a point previously stated by NHS England’s head of primary care Dr David Geddes in an interview with Pulse.

Dr Bewick said: ‘Workforce planning… in this country, it really isn’t something that we are good at. I think that we are not actually choosing well at the basis of entry to medical school. We are not looking at people who want to serve their community as well as do medicine, and I think that we need to go back to the beginning of choosing of doctors because most of the reasons for why people are going into this has nothing to do with their local practices. We have got to get something out there which shows what a really wonderful job this is.’

‘We have got to go out to the schools, and it might mean that we have to do more workplace programmes with younger people to show that this is where you want to work for the rest of your life, because it is exciting, interesting and innovative.’

Speaking to Pulse about the issue of GP pay, Dr Bewick said: ‘The workforce issue is one about retention and recruitment. The issue about whether that is related to pay directly is probably very slim because we know people come into medicine for lots of other reasons other than just earning money. The issue that I think we have got to address is that many doctors are worried about the system at the moment and they are looking to leave it. We have got to make their workplace a better place to work in so that they don’t feel under so much pressure, and what we have been trying to do with the contract is to give them the headroom to do that.’

‘That was part of what I was trying to do today, to give them some confidence that NHS England is on their side to try and make change.’

Asked whether recommending a pay rise may have given GPs some confidence, Dr Bewick said NHS England would ‘rather’ GPs improved their model.

He said: ‘I’d rather we gave them resources to improve the service, which might actually decrease the amount of work on them. It would be very difficult in this situation, where you’ve got other parts of the workforce losing their jobs, and other parts of the workforce on virtually negative [pay development]. Particularly as GPs are not the worst-paid part of the system, I don’t think that would go down well with people in the health service who are on a more moderate pay either.’

NHS England has launched its ‘Call to Action’ to explain to professionals and the public why they think that primary care has to change its ways of working, and help CCGs shave £30bn off the cost of running the NHS. The call has been supported in research papers by the King’s Fund and Nuffield Trust, as well as the RCGP, which have said GPs must join together in federations for general practice to remain affordable and sustainable in the long term.