GP recruitment has been in crisis for as long as I can remember. We’ve had the odd positive development recently, including an increase in training numbers. But, in general, the picture is as murky as ever.
Since November 2019 when Matt Hancock pledged to increase GP numbers by 6,000, the full-time-equivalent, fully trained GP workforce in England has decreased by 200. And since his predecessor Jeremy Hunt made a pledge to increase numbers by 5,000 in 2015, we have lost 1,300 FTE GPs. Unless Sajid Javid can start offering the bankers’ bonuses he is used to, I can’t see him having much more success.
But I feel that everything we knew (or, more likely, didn’t know) about GP recruitment will be almost redundant once we come through the Covid crisis.
The pandemic is prompting many GPs to take stock. Some are focusing on their own physical and mental health; others have realised remote working is a route to a better work-life balance. At this point, it is easy to blame the state of general practice for this shift in mindset. That may be true in many cases but it’s not necessarily the driver for all those GPs who are reviewing their careers.
Instead, this is an issue faced by all professions and industries. It has gone under the radar, but the giant management consultancy Deloitte has brought in a policy of ultra-flexible working, allowing employees to decide where and when they work. It will not be alone.
Of course, this is harder in general practice. The approach by NHS England around face-to-face appointments was so clumsy and heavy-handed partly because GPs are already so aware of the importance of patient contact.
But this genie won’t go back in the bottle. GPs will rightly demand to be empowered and have flexibility to control their work-life balance. And the onus is on policymakers to design a framework that facilitates this.
NHS England’s ‘People Plan’ asks ‘GP practices and primary care networks to offer more flexible roles to salaried GPs and support the establishment of banks of GPs working flexibly in local systems’. This seems typical of the piecemeal policies that have failed to stem the leak of GPs, and I can’t see it faring any better.
What is needed is a wholesale review of general practice, taking into account the needs of GPs as well as patients. It should look again at what GPs can and can’t offer, and what level of service patients can expect – the very opposite of what is happening in England, where GPs have had Hancock in one ear demanding remote consultations, and NHS England in the other ordering face-to-face appointments.
This is one reason for Pulse’s campaign to build a better general practice. I’ve seen a number of GPs say a magazine shouldn’t be running this campaign. I couldn’t agree more. But it doesn’t look like anyone else is doing so.
For the system to work we need to define the purpose of general practice, but recognise nothing will be achieved without a contented workforce.
The pandemic is changing society, work and of course general practice. And unless the powers that be change with it, GPs will decide it isn’t worth their while to keep propping up the failing system.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at firstname.lastname@example.org.