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I fear the only solution to GP workload will never happen


GP workload


Chatting with Copperfield about his column, I was playing devil’s advocate (no, not that one). What exactly do you want, I asked. You complain about too much work, then, when you get support, you moan about work being taken away.

Using a voice normally reserved for a parent who’s brought little Johnny in with a runny nose, he explained the three ways to tackle rising GP workload: divert the work; contain the work; and reduce demand.

In England, especially, the focus has been on the first. PCNs have been given all types of healthcare professionals to remove work from GPs. But diverting the work is the worst option. It leaves GPs to deal with more bureaucracy and the trickiest patients. It also has the effect of both making them redundant (see Copperfield) and overworking them when the HCPs are off sick, or funding is removed.

And it hasn’t worked. Our cover feature reveals that the volume of workload now is the same as when we did our first workload survey in 2019.

Yes, the pandemic hit in that time but that seems mostly to have affected the nature of workload rather than the volume. The problems of face-to-face contacts have simply been swapped for those of remote consulting. A year on, practices are back up to normal appointment levels.

Increasing GP numbers would of course help, but create more supply and it will be filled, just like adding an extra lane to the M25 or an extra bin in the kitchen.

So how about containment? Cutting working hours or capping appointments would help GPs but politicians will always put voters’ demands for convenient access over the welfare of GPs.

That leaves reducing demand. The obvious route is to introduce a charge to use GP services – as a couple of our bloggers argued last month. Stop making services free, they said, and the demand will reduce. I am uncomfortable with this for many reasons, but mainly its potential to increase healthcare inequality.

Could a culture change in patients’ relationship with the NHS ease demand? For all the errors of the past year, the ‘Stay home. Save lives. Protect the NHS’ message did seem to get through. Keeping ‘Protect the NHS’ could reduce demand. And there is a part of the NHS that does curb demand in this way: A&E. It even requires 111 referrals now. But A&E is hardly the poster child for safe levels of work.

There are ways to reduce demand – but they are not easy. 

First, politicians could make brave decisions on what the NHS can provide. Prune screening. Instruct NICE to tighten thresholds for two-week referral and approval of new treatments. These are unpalatable for everyone, but they would work and are achievable. 

There is a palatable solution, however, that won’t affect patient care. We need to acknowledge that patients who use GP services do actually have problems – but the causes are largely societal. Austerity has had a disastrous effect; deprivation is the biggest predictor of poor health, so closing the equality gap is the only real solution.

Since that will never happen, good luck with appointing your new practice physiotherapist!

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk.

READERS' COMMENTS [3]

Vinci Ho 9 April, 2021 6:37 am

Thanks Jaimie for this insightful , realistic and clearly ominous analysis.
Only journalists who have been involving closely with GP-land would be able to reflect these arguments in precision .
Sadly , the reality is , recruitment and retention crisis is escalating rather than having found solutions.
I personally have announced my plan of stepping down from GMS partnership to all my partners.

Thomas Robinson 11 April, 2021 9:57 am

Interesting analysis, though as Copperfield is an experienced,well educated, insightful intelligent GP, I take an opposite view.

My own approach, would be to not to try to solve the problem.

The fundamental basis of General Practice is close to insanity. Tomorrow morning the average GP is available to 2,000 patients, all of whom have a right to present an unlimited number of problems, in any order and no particular order. Any referrals may be answered at some unknown date in the future, or never answered at all.The list of implausible assumptions is endless.

What if the NHS were taught to schoolchildren, as a GCSE subject,the bald facts,with no GMC/RCGP hysterical claptrap.

Allow the public to grow up knowing the true scale of the nonsense.Allow them to judge and campaign for change.

In the end,any change will be dependant on their consent

Gerard Bulger 16 April, 2021 11:58 am

The professions itself created this mess. We have all gone part time, leaving no flexibility. One less appointment less than needed a day rapidly builds up into two week or longer waiting times, making it seem that the demand is infinite. Then we broke up into specialist creating multiple appointments and wonder why we cannot offer any. We have given up being responsible for our of hours, which is not the same as having to do it, but meant there is no incentive to see in hours. I had a list of 2,700 + 800 prisoners with 1.3 full time doctors and we never had waits more than 48 hours. Post natal mam and baby is one example of all done and baby imms in one 30 minutes consult, with nurrs, not requiring multiple. Some partnerships the mother has to book in three or four times for each part. I have worked in Australia is areas of great doctor shortage, and there is no such thing as three weeks to see a doctor, as doctors are paid fee for services, which is fantastic for patients getting appointments (the system is poor for chronic disease). I good day in UK is few or now patients turning up. That is a bad day in Oz. Zero patients= Zero income. Funny that where there is an incentive to se patients they are seen. Perhaps that is the change needed. An element of fee for service.