Editor Jaimie Kaffash warns that the new workforce plan falls dangerously short on GP retention and workload
It all boils down to workforce. Almost every problem facing GPs and the profession stems from GP numbers – we have lost more than 2,000 full-time equivalents since 2015 in England. I must have quoted that number more than any other as Pulse editor.
Everyone recognises this. The Government, NHS England, the BMA, the RCGP, the GMC and every other stakeholder. The same applies in the devolved nations.
The Government’s response – its workforce plan – finally landed on 30 June. Although it was due in 2022, I hesitate to describe it as ‘long awaited’ as no GP really expected it to solve the issues in general practice.
It is easy to say the plan disappoints but our investigation into the ‘five stages of recruitment and retention’ shows exactly why this is true.
The headlines revolve around education and training and, on this, there are truly positive developments. The increase of GP training places to 6,000 and the doubling of medical school places are vital.
However, training and education isn’t the problem area. Health Education England has actually done a great job on this already. It has improved GP training take-up, met all its recent targets and helped reduce the ridiculous stigma around primary care in some of the more stuffy medical schools. As our figures show, around a third of those entering UK medical schools become fully trained GPs.
But there aren’t enough qualified GPs to train them. This, of course, is a symptom of the underlying problem: we are failing in terms of retention.
GPs are, on average, working fewer sessions than in 2015. Some of this is generational – these figures are most stark in the 30-50 age range, and workers of this age in all sectors are reducing time in work in favour of childcare or other caring responsibilities (and this should not only be factored in but encouraged).
But that is not the whole story. The main reasons for GPs reducing hours, going to private practice, moving abroad or leaving the profession altogether are burnout and unmanageable workload. Indeed, many GPs who officially work ‘less than full time’ in reality still do what other professions would consider full-time hours.
On this, the workforce plan draws a blank. The section on retention focuses on secondary care, and how to build a culture where everyone feels welcome and valued (I’d venture that proper pay might help with this).
I don’t blame the authors for overlooking GP retention; this is simply not in the remit of workforce planning. The only relevant point in the whole plan is this: ‘We must recognise the influence staff shortages have on organisational culture, and an individual’s experience at work and decision to leave.’
The solution is straightforward but difficult: make the job more manageable. This is not a workforce issue – I’ve long argued that improving recruitment is not enough. It requires a radical change in demand, such as that produced by removing out-of-hours work in 2004.
I’m still unsure what this should be (luckily, editors can point out problems with no accountability for solutions). But I fear any reduction in demand on GPs will entail an increase in wider public service funding, which seems unlikely regardless of who is in power next year.
Increasing the number of new GPs is essential. But unless the intense workload faced by today’s GPs is addressed, they will continue to leave the profession. And that is the real challenge.
A version of this column originally appeared in the July/August 2023 issue of Pulse