As Pulse publishes its major comparison of conditions in general practice across the world, editor Jaimie Kaffash reveals why UK GPs are in the deepest merde
It is an achievement of sorts. The UK Government has outflanked its counterparts abroad in making general practice worse than anywhere else. GPs here have lower morale, lower satisfaction with pay, shorter appointment times and are more likely to leave the profession.
A devil’s advocate might point out that UK GP pay compares well with international peers, average working hours are no more strenuous than in many other countries and the average number of patient contacts a week is roughly the same as elsewhere. Are UK GPs simply more vocal than their overseas counterparts?
But scratch beneath the surface and things become clearer. In the UK, a week’s worth of hours and patient contacts is often compressed into three days, and pay is better because there are fewer people to share the funding pie. The intensity of their appointments is also higher, dealing as they do with patients who would be seen by specialists in other countries.
In England, the GP contract is set for an overhaul next year and I’m not alone in having called for fresh thinking. And there have been radical suggestions: a salaried service, co-payments and payment by activity, among others.
But researching models across high-income countries, it was clear to me that no one model stood out. Each way of organising general practice had its good and bad points.
The one magic bullet, of course, is a greater number of GPs. This improves morale, workload, consultation lengths and everything else bar pay. But as I have argued before, this seems like a bit of a lazy suggestion. All countries are struggling with GP recruitment and I almost feel sympathy for the Government’s forlorn pledges to conjure up a load of new GPs. Higher numbers of GPs are as much a consequence of a strong profession as a cause.
But another solution lies within ministers’ power – although it’s one they may not want to hear. GPs and general practice thrive when they have the right social infrastructure around them. For me, this might be the main reason UK general practice is worst among equals.
Underfunding isn’t the only consequence for general practice of the brutal austerity imposed on the UK over the past 13 years. Even if GP funding had kept pace with inflation, I am not sure it would have prevented crisis (although it would certainly have mitigated the problems).
So much of GPs’ time is now spent filling gaps elsewhere in the system, most obviously in secondary care. UK GPs have always had more responsibility than international counterparts when dealing with specialist conditions. But the trickle of workload from secondary care is now a flood, and reported plans to expand advice and guidance may drown many GPs.
GPs are also the fallback option for the people let down by the UK’s neglected social and care services. Contrary to media coverage, they are the one group of professionals who are always accessible.
Yes, there are other countries with low spending on public services. But the UK is almost unique among them in having universal free healthcare (which, if it is not clear, I’d be loathe to give up).
I’ve said this before, but UK GPs are victims of their own success. Accessible, knowledgeable enough to manage long-term conditions and able to provide unlimited free care for £100 per patient. But unless they can focus on their core skills instead of acting as a general safety net, no change in funding structure will lift morale.