In September 2015, there were 28,100 fully qualified FTE GPs in England. In June 2021, there were 27,700, a 1.3% decrease. In February 2019, there were 25 million general practice appointments in England. In July 2021, there were 28 million, a 12% increase.
The UK-wide picture is similar. I have not cherry-picked the figures, they are the latest from NHS Digital. They are simple yet stark: the number of appointments is going up as the number of GPs is going down. Any other debate around general practice is just noise.
And the noise has become a cacophony – louder than I have ever heard. GPs are accused of being closed, lazy and negligent. This comes from all quarters, including the health secretary, who wouldn’t miss the chance for a good headline.
But Sajid Javid’s veiled threat that it is ‘high time’ GPs provided face-to-face appointments is typical of the opportunism of this Government. It also shifts the narrative away from the central point: appointments are going up while GP numbers are going down.
There might be ways to mitigate this increased demand at a time of fewer GPs: the use of additional healthcare staff, or moving to more remote consultations. These changes are both controversial: the former is basically using less-qualified HCPs to do GPs’ tasks, and we’ve seen the furore whipped up by the media reaction to remote consultations. Other initiatives may well be tried but they won’t change the fact: appointments are going up while GP numbers are going down.
Patients’ frustration is understandable. Sadly, some have died who may have lived longer had they been able to access face-to-face care during the pandemic. But this is inevitable where there is overdemand and undersupply of health services. The perceived lack of face-to-face appointments is a symptom, not a cause, of this fundamental structural problem.
And it’s not as though we can look back on February 2019 or September 2015 as halcyon days. General practice was bursting at the seams even then. Yet, since then, appointments have been going up while the GP workforce has been shrinking.
I’ve previously argued that a positive message about general practice is the way to bring about change in the longer term. But in the shorter term, there is a crisis of public opinion – GPs are convenient scapegoats for everything wrong in the NHS. In a just world, any report around GPs would contain this crucial line: appointments have increased while GPs numbers have decreased.
Much of the media can’t be trusted to do this. Negativity around general practice is fuelling itself. A MailOnline story even blamed an increase in stillbirth on GPs’ refusal to see patients face to face, although the report it was based on did not mention GPs, who in any case are not responsible for maternity services.
And Mr Javid has shown the Government can’t be trusted either; it prefers to increase patient demand while making lacklustre efforts to boost GP numbers.
So it becomes incumbent on the BMA, the RCGP and, of course, Pulse to repeat the mantra. Because it is ‘high time’ Mr Javid and his colleagues took some responsibility for the mess they have caused.