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Dr Dean Marshall: ‘Patients are beginning to realise their local practice is under strain’



General practice is under unprecedented pressure with many practices on the verge of breaking point. This is the reality that GPs are facing and this is why today the BMA has launched its new campaign, Your GP Cares, which is calling for the sustained investment that GP practices need across the country.

A key part of the campaign will be to highlight to the public the real obstacles that are getting in the way of GPs delivering the care that patients want expect. Many of these are already becoming apparent to patients although politicians and policy makers continue to ignore them.

The most pressing concern is that we are now seeing a relentless conveyor belt of workload.  GP practices are seeing a steady rise in the number of older patients needing longer appointments to manage complex medical problems which reflects the changing demographics in the wider population. By the end of the next decade those over 65 will top 15 million, up 5 million from today.  Many of these patients have complicated conditions that are not straightforward. By 2021, 1 million members of the public will be living with dementia while 3 million are expecting to living with or beyond cancer by the dawn of the 2030s.

I could go on quoting figures, but I know most GPs are already dealing with a heavy burden of complicated cases that is getting more and more pronounced. And crucially, they will also know that the Government is not providing the funding to allow us cope with this extraordinary rise in workload. Our resources have flatlined for years, while the cost of running a practice is continuing to rise. Practice expenses now account for 61% of all practice income.  This leaves no spare funding for GPs to upgrade their premises which in many cases are not appropriate to cope with the demands of 21st century medicine.

Given this climate it is unsurprising that patients are beginning to realise that their local general practice is under strain. Its most obvious manifestation is the difficulty in obtaining an appointment because of the volume of people who need them and the fact we don’t have enough GPs to provide them to patients.

This is why it’s the right time to launch a forceful campaign that doesn’t just publicise the problems facing general practice, but seeks to offer positive solutions to get us out of this worsening crisis. The solutions we need can be divided into three main areas. We need a sustained recruitment drive that gets more GPs working in local practices. We need a similar effort to recruit more practice staff. And we need to bring GP premises up to scratch so they are fit for purpose to deliver care to our patients.

Practically, we will be using direct communication to patients to get our message across in the form of posters and other materials. We will be lobbying parliamentarians and other stakeholders and continuing to draw attention to practices who are in trouble, as we have done recently with those affected by the withdrawal of MPIG.

Now is the time for the government to face up to the fact that general practice needs help – we cannot continue to stick our head in the sand and hope that the problems facing general practice will just go away.

Dr Dean Marshall is a GPC negotiator and a GP in Midlothian.