GP recruitment and retention crisis has received unprecedented political attention and media coverage in the last few weeks. Whilst it was a refreshing change to hear the health secretary acknowledge the issue, yet another review of the workforce issue has been commissioned (despite excellent fact-finding and recommendations from the poorly-publicised workforce task report and Centre for Workforce Intelligence reports), it was also disappointing to hear the NHS England chief Simon Stevens to suggest that we must reflect on the damage such issues have caused to the cause of general practice. Of course, in the same speech, he did not forget to mention the NHS England staffing shortage and funding constraints.
The cynic within me says that we are being forced into the corner, asked to accept other alternative untested models of care that threated a model that deals with the 90% with less than 9% of the funding.
Some say that the issue is cyclical and will go away and I really hope so, but do not believe that will be the case. Currently, it is not easy for any practice to recruit but many areas are disproportionately affected, especially the north of England, and more so if you are away from a city and work in an area with high deprivation. This was very much acknowledged in the reports mentioned previously and follows the inverse care law. I work in an area that ticks all of these boxes. Many local practices have struggled to replace those retiring or emigrating, despite offering flexibility of salaried or partnership and full-time or part-time work. Whilst the national discussions, reviews and negotiations continue, there appears to be little hope of any immediate relief or measures to ease this issue.
I am currently one of the six directors of a GP collaborative, South Durham Health CIC, and we are in the process of writing an open letter to interested parties, including the area team, CCG and local MPs. We want to highlight the crisis and work together to some immediate local measures to approach the problems of the recruitment crisis, as we are disproportionately affected in our area.
Think global, act local
For any hope of protecting one of the best and most cost-effective health systems whose fundamental success relies on the model of general practice, it is absolutely essential that we take the matter in our hands and take local and regional steps. We must work with our patients to make them aware of how desperate the situation is and how close we are to an end to the current model of general practice. We need to lobby with patient groups and MPs to highlight our concerns.
We also need to work with our CCGs, our colleagues, to secure support for the worst-affected practices. We need to be asking for support from our area teams especially at this critical juncture when PMS reviews are upon us. But it is also important that the CCGs, LMCs and area teams are mindful of how overstretched we are amidst the talk of seven-day general practice.
Funding alone is not going to be enough. We need better infrastructure and golden hello schemes. We need local campaigns to promote why we are still doing the job and what it really means to look after someone from ‘cradle to grave’, the phrase we use so often. We need to target schools at sixth-form level, medical schools and foundation doctors to promote a positive image of being a GP, and impact we make on the lives of the population we look after. We need to become better at celebrating our own contributions and what we are good at: looking after an individual rather than a disease.
Some of our local colleagues have served tough areas for years, showing great commitment. So we need to tap in on their expertise and support them to be able to work longer with local incentives – perhaps just recognition, additional leave, and support. Let’s bring in and support more training into such areas at all levels, including foundation years.
Some areas have already started to look at federated models of training as well as federated locum banks. To this end, our local GP collaborative-cum-federation is taking the initiative to work towards local solutions. But if we keep waiting for someone else to sort this out, the wait will be painful and endless. It is vital that we all put aside our scepticisms. Only then, we can survive and preserve such a valued health system. Ultimately, it is our own problem and however disgruntled we may be with the state of affairs, anyone who’s proud to be a GP is a part of the solution.
Dr Kamal Sidhu is a GP in Country Durham, and one of the six directors of South Durham Health CIC.