General practice is reaching ‘saturation point’, NHS England admits

General practice activity is approaching ‘saturation point’, an NHS England director admitted just a day after the new GP contract imposition.

Speaking at the Best Practice conference last week, NHSE’s director of primary care transformation Dr Minal Bakhai said that within general practice ‘need is increasing’ but ‘growth in activity is slowing down’. 

She also told attendees that while GP practices ‘desperately need more funding’, there is no ‘clear route to that injection’, which means the system needs to ‘deliver services differently’.

On Wednesday last week, NHS England announced changes to GP contractual arrangements for 2024/25, as part of its third contract imposition. 

Investment in general practice will increase by just over 2%, which equates to £249m, and part of the QOF will be income protected. 

The new contract was not well-received, with the BMA calling it ‘an ideological dismantling of NHS general practice’ and warning that the GP business model is ‘now non-viable’. 

NHS England’s national director of primary care Dr Amanda Doyle has since admitted that the changes for 2024/25 will ‘only make a tiny difference’ to practices.

Her colleague Dr Minal Bakhai avoided discussing the new contract with conference attendees on Thursday, but acknowledged that general practice is struggling. 

She said ‘demand has gone up’, particularly due to an ageing population, while ‘capacity is falling’, with the system losing around 2,000 GPs since 2015.

‘And if that was not enough of a burning platform, what we’re starting to see is that while we know need is increasing, actually the growth in activity is slowing down, which suggests that we’re getting towards saturation point – and that is most pronounced in the areas of highest deprivation, so practices like mine,’ Dr Bakhai said. 

Recent NHS data for December 2023 showed that GP practices delivered 25.7 million appointments, an increase of two million (9%) compared to the same month before the pandemic.

Dr Ruth Aynsley, a GP partner in Gateshead, told Pulse general practice has gone ‘beyond’ saturation point and that she feels ‘totally’ let down by the new contract. 

‘I think we’re beyond saturation point, honestly. I could cry talking about it. I just feel completely despondent with it,’ she said. 

Dr Aynsley added: ‘It’s interesting that [NHS England is] saying we’ve reached saturation point because I know there’s been a lot of stuff about general practice being the only area that’s performing above pre-Covid. But I think it just can’t go on.

‘I think a lot of the reason we do go on is because we all feel really committed to our patients and we really want to have a good outcome for them, but actually, after a while, it becomes that if we’re not well ourselves, it’s probably not sustainable.

‘Honestly at the moment I feel I’d be happy to just walk away.’

Doctors’ Association UK (DAUK) GP spokesperson Dr Steve Taylor told Pulse that general practice has been at saturation point for years, and that it is ‘very strange’ chancellor Jeremy Hunt refuses to fund GP practices further despite understanding these pressures.

Responding to Dr Bakhai’s comments, he said: ‘I think it’s 100% true, general practice has been at saturation point for several years. It’s amazing to me that we’ve managed to do as much as we have over the last two to three years since the pandemic.

‘I think most of that’s been done on goodwill and hard work, but most doctors, as has been vented on Twitter [X] and other places, have reached the limit, and I don’t think there’s any more capacity in the system to give.’

Dr Taylor said that due to Mr Hunt’s previous role as chair of the Health and Social Care select committee, he ‘does know that general practice does need the money’.

‘It’s very strange that we have somebody in the Treasury who understands general practice but won’t fund general practice,’ he said.

A GP in Yorkshire said Dr Bakhai’s comments are ‘remarkable’ since NHS England ‘remains silent on poor, inaccessible care, avoidable deaths and bad outcomes’.

‘The public now face underfunded, dumbed-down primary care and will respond in the ballot box,’ he added.

NHS England’s primary care transformation director also pointed to further problems over the next 15 years, with ill health expected to grow by 37% but the working population only increasing by about 4%.

This means the revenue generated by the working population will not ‘keep up with the growth in need’, she claimed.

Dr Bakhai said: ‘So while I think we would all agree that we desperately need more funding, there is not a clear route to that injection, particularly when we’re already hitting Scandinavian levels of taxation – so that means we need to deliver services differently.’

Her session at the conference promoted the benefits practices can reap by moving towards ‘modern general practice access’, a model which was laid out in NHS England’s GP recovery plan last year.

Practices can work towards the model by joining the national General Practice Improvement Programme, which helps GP teams to tackle the ‘8am rush’, provide rapid assessment and response, and avoid asking patients to ring back another day to book their appointment.

However, Pulse reported last month that GP practices were struggling to take part in the programme due to lack of capacity, with almost half of ICBs highlighting low uptake in their regions.