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Dr Chaand Nagpaul: ‘Grassroots GPs are offering to dig politicians out of their own mess’



If the government needed any further evidence that GP practices are being stretched to breaking point they need only to look at GPC’s latest survey of the profession. But they should also listen to the clear solutions that grassroots GPs are offering to help dig politicians out of the mess they have made of general practice.

More than 5,000 GPs in England responded to our poll and unsurprisingly it revealed that that workload pressures were unsustainable in every part of the country. Eight out of ten GPs in all English regions said their workload was either excessive or unmanageable.

The worst affected areas were the South East, the West Midlands and Yorkshire and Humber with 86% saying their daily routine fell into this category, but the lowest response was 83%, showing a remarkably uniformed national picture. From the North East to the South West, from the big urban cities to far flung rural areas, the view is the same: GP services are being spread so thin they are struggling to provide even basic care to their patients.

The alarming consequence is that more than 8 out of 10 GPs say that they are unable to provide safe and quality care. Therefore if the government seriously wants to improve patient safety, it must first address this environment of engulfing unmanageable workload pressures on GP practices, rather than continue with the flawed Care Quality Commission inspection regime, with its cumbersome and expensive inspection process taking both time and resources away from GP practices, and in turn exacerbating GP pressures.

The reasons for these survey findings will already be clear to every GP reading this blog. We’ve been subject to a decade of underinvestment at the same time as rocketing patient demand, spurred by an ageing population that needs more complex care. Staff shortages and more work being moved from hospitals into the community have added to the long term pressure and matters have not been helped by a catalogue of failed political projects.

The decision to outsource back office operations to Capita has been an unmitigated disaster which has delayed the transfer of patient records and the ordering of medical supplies, leaving GPs and their staff with another impediment to doing their job effectively.

In our survey, GPs however look beyond the problems and offer real solutions. Increased funding, as the GPC has repeatedly called for, is at the heart of repairing the damage done to general practice.

But other measures need to be taken. GPs call for the increased provision of enhanced community nurses to manage vulnerable housebound patients and more mental health workers, demonstrating that GPs get what politicians don’t: namely that we need a more flexible, specialised primary care team in our communities to support GPs. There is also a clear call for greater provision of self-care support to patients for both minor illness and self-management of chronic diseases, to reduce avoidable demand

Many of these proposals were mirrored in the BMA’s Urgent Prescription for General Practice, which NHS England accepted a few months ago. But while that acceptance was welcome, what GPs want to see is one thing and one thing only: delivery. We need the promised funding, the promised extra support and the promised additional workforce to begin to arrive in GP practices throughout the country. And we need the short term mess of the CQC and Capita to be addressed in full.

Having got the government to recognise the enormity of the crisis in general practice, GPC is now pressing hard for the government to deliver on their promises, and is putting in place a system to track this with the help of LMCs. The time for warm words is clearly over: it is time for ministers to make their pledges a reality.