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When do we admit defeat?

practices businesses

There might be some disagreement around the GP recruitment crisis. 

Some might argue that replacing the shortfall in GPs with other healthcare staff is a policy worth pursuing. But this is a moot point as even this plan B is not working. The raw numbers of staff hired might look good but they are not helping with the workload crisis. To paraphrase Alanis Morissette, it’s like 10,000 link workers, when all you need is a mental health professional. 

Some (ie, Conservative politicians) might disagree over where the blame for the problems lies. But anyone with any sense and no party affiliations knows it lies with those in power for the past 12 years. 

But everyone who is anyone – ministers, NHS England, the BMA, the RCGP and all those in between – insists that focus should be on the task of recruiting more GPs.  

Everyone but me, I guess. Because I’m starting to think there’s no point in persisting with this aim. That’s certainly not because I don’t think we need more GPs. We clearly need more GPs than ever before. 

And it’s not that I think it can’t theoretically be done – it can, or at least it was certainly possible until fairly recently. Theoretically, a government with a true commitment to increase GP numbers would have been able to. The huge funding injection in the 2004 contract certainly helped to increase GP numbers, after all.

The problem is that it can’t be done in the world we are living in. First, we have a government that, for 12 years, has shown it is unwilling to do what is necessary – put the required money into general practice and agree a contract that will get people entering into and returning to the profession. For at least eight of those years, this has been a workforce crisis. It is not for turning now and it’s easy to see why. They’ve been successful in blaming GPs for problems with access. Electorally, the lack of GPs isn’t harming them, and that’s all they care about. 

Whether this is fair on GPs (it’s not)– or even whether the BMA or RCGP are at fault for losing the argument – is another moot point. Arguments around fairness aren’t working, and while we pursue these arguments, GPs continue to work 12-hour days. 

Second, I feel we have gone beyond the point of no return – for the next decade at least. The RCGP rightly says we need more than the 6,000 GPs the Government is notionally targeting. GPs responding to our survey suggested one in six positions is vacant – and that doesn’t take into account those who have simply given up recruiting. 

So let’s admit defeat on the ambition to recruit enough GPs. Instead, let’s fight another battle based on the 2004 contract. Let’s focus on removing chunks of work that simply cannot be done with the number of GPs we have now. And we need to think big. In 2004, it was out-of-hours work. This time, how about getting rid of urgent same-day care from general practice – as hinted at in the recent Fuller report? Or long-term conditions? Or vaccinations, screenings and other preventive measures?  

This is an argument that can be won relatively quickly. It might see funding moved away from general practice. But that might be a necessary sacrifice and, with the tight margins involved in providing some services, the effect on pay might be relatively limited.  

Instead of waiting for the rain to stop on your wedding day, limit the scope of the celebrations. It will probably lead to an increase in GP numbers, ironically.

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

READERS' COMMENTS [10]

Darren Tymens 4 July, 2022 10:06 am

The solution is simple, but unpalatable for NHSE and the government: *fund general practice appropriately* (even if that means reducing funding to hospitals and forcing them to be more efficient).
There are enough GPs, but they/we have drifted into other work because the main job is so difficult and unsatisfying. Make it do-able and satisfying and they will return (though they may need convincing and incentivising).
NHSE and the government also need to stop pretending that other solutions are viable – they aren’t. ARRS staff are expensive and cannot do what GPs do. Integration is just a meaningless buzz word. Fuller does nothing other than rearrange the deckchairs – they will still need GPs to deliver the care, it will be dunped on PCNs, and all it will achieve is a rearrangement of the reducing number of deckchairs and a disempowerment of practices and the profession.

Jane Boskovic 4 July, 2022 10:55 am

There is a huge representation of GMC registered Doctors who would love to work as GP’s, but, the current UK recruitment process denies us the opportunity. The crest ticbox process is impossible to fufil in most positions and so international recruitment of young trainees continues according to this process, overlooking the rich experience actually available. A suggestion … start the process with the exam with GmMC registration mandatory … as done by the RCP, this sorts out potential immediately, provide a 3 month induction job to bush up basic clincal skills, remove the massive paper gathering and replace it with time spent in mental health, drugs and alcohol, occupational medicine useful stuff for any GP. Stream General practice into subpecialisations: ie 1. Young families and womens health, 2 18 to 65 .. The population at work and 3.Elderly medicine.
More trainees on flexible training programs will be generated and retention will improve.
Keep the rigorously final exams to uphold standards.
Provde a job in GP practices for GMC registered doctors to work under supervision to identify potential and help current GPs.

David Church 4 July, 2022 11:03 am

Quite right Jaimie.
Secondary care has been pinching the best deckchairs and throwing the broken ones to GPs to mend for years. The deck-chair lease process for GPs is excessively and unfairly complicated, and overpriced, and leaves GPs fighting amongst themselves for spare parts, whilst telling patients that GPs are in control of all the deck-space, but hiding in the life-boats (of which there are not enough).
And the passengers have been aggrieved by overcharging for the cruise tickets, and additional fees for things they were wrongly told were included in the ticket price.

Vinci Ho 4 July, 2022 12:44 pm

Jaimie , while you talked with a lot of common sense here , the government led by this PM are currently refusing to admit any defeat or failure for obviously political reasons . The rhetorics from DHSC is this government had invested abundantly into a post Covid recovery plan and more GPs have been trained .
I totally take the argument that the total number of GPs around might be ‘enough’ but it is all about those actually working at the frontline. More colleagues are burnt out and that means others will be even more protective of themselves , hence , cutting down frontline commitments. And ARRS cannot replace GPs in many aspects especially in the territory of continuity of care for the patients and their families .
The Health Secretary , policy makers and academics are simply burying their heads in the sand

Patrufini Duffy 4 July, 2022 4:12 pm

As the end has been created by the ICS and PCN (sheep), attention should now turn to who is coming next and what form of control, intimidation and monitoring are they setting up. You are going to get utterly shafted from all quarters. That is fact. I cannot believe you still sign up to their PCN herding, just to make a quick dollar and feel “safe”. Where in fact, you are going to be dissolved. Voiceless bar charts and infographics. Data is destined for US corporations, and insurance companies are ready and the sell off is vastly underway. The final piece of this, whether it works or not, is to remove you. It’s already in full swing. The future of Pulse probably may lie in investigative journalism that makes the public aware of who is here, and who is coming. Only the public in their millions can save this dissolution. It has or is the end. And Pulse may not have any role of need in the future health system which is commanded and controlled with no interested GPs left for the gutter of state care.

Nigel Dickson 4 July, 2022 6:11 pm

The GP system is broken, and current Tory ruling classes sorting out sticking plasters isn’t ever going to be the answer. Serious money needs to go into the fabric of general practice to make it attractive to newly qualified doctors to want to spend their life careers tending to patients in community settings. Just tried to get a routine appointment at my own GP practice but they don’t have any – all routine appointments are fully booked for the next 3 weeks and they are not releasing any bookings beyond that 3 weeks at present so I can’t book ahead. On pressing the receptionist as to when I might be seen she revealed that they plan next batch of routine appointments will be released by the GP’s management in 10 days time when it was suggested I might try again to see if I could get a routine appointment then when the next batch of routine appointments are released. You couldn’t make this up. Which management consultant team dreamed this nonsense up? The good news is telephone answering – that has improved no end – only had to ring in once and after listening to the speal about 111, 999 and every other Tom, Dick & Harry the number choices came up and number 2 wait was only about 10 minutes to get through and I didn’t get cut off. So a good news story there – day time GP telephone answering has moved on light years from 2 years ago. But not allowing patients to routine appointments – how does that help? If you lie and say its an “emergency” then presumably that’s off down the 111 route, or 999 if you really lay the lies on thickly. Don’t think Joe public is going to support a 30% pay increase for their GPs do you – and if they go on strike – frankly would patients with routine complaints really notice? Perhaps GPs are already on strike? No routine appointments for 3 weeks, try back in 10 days time – but obviously no promises – sounds a bit like GPs are already on strike?

Simon Ruffle 5 July, 2022 11:00 am

Truly astonishing that a Tory government want to nationalise GP.
We get accused of profiteering whilst we would blow the inflationary pressure if we charged. The less a service is available, the more it costs, market forces at its best. We could be more conservative than the C’s
If there aren’t enough GPs, get someone else to do the job. It couldn’t be more expensive because we’re earning 100s of Ks and filling the treasury

Patrufini Duffy 5 July, 2022 10:20 pm

Yes Nigel. Well I called my dentist today. They won’t see me on the NHS as they have a “waiting list”.

But they’ll see me at 2pm privately tomorrow.
Rrrrrriiigght.
Makes sense.
And that’s all good.

What a joke.
Imagined if GPs applied that principle. Sounds like NHS Consultants sometimes. General Practice of the dark ages.

C Ovid 23 July, 2022 10:57 am

While we still have independent registration with the GMC, we have time to jump ship en-bloc. If we leave it too late , we will have the NHS reaching in to our fitness to practice and reinforce their uncontested monopoly. It would be sensible for the govt to force us to work only for them (rather like being in the Armed Forces) and then they can control our costs and behaviour.

It really is time for the BMA to take us out of the current NHS: it is so suffocating. We spend so much time discussing service issues when we should be improving our clinical skills, learning and incomes (let’s be honest here).

Give all the NHS budget to secondary care: they have nearly all of it anyway! Provide insurance-backed primary care with Govt oversight (to protect the vulnerable). I haven’t met anyone recently who wouldn’t pay half of their Sky subscription for a more responsive and appropriate GP service.

I think we are more unrealistic than the Govt sometimes.

C Ovid 23 July, 2022 11:14 am

and the NHS pension? Not a good enough reason to stay. If you earn more, you can put more into normal investments anyway.