The major challenges that currently face GPs are not CQC and revalidation – or even clinical commissioning. Rather the rising workload, and the increasing complexity of the cases we see every day, are what make our lives stressful.
Over the past two to three years, changing casework has led to overwhelming demands on GP time – and this is before GPs start working with their CCG to move work out of hospitals and provide more care in the community. Practices are facing falling profits and greater difficulty in recruiting new partners or salaried GPs. A significant number of GPs facing major pension changes have already decided retirement looks like an increasingly attractive option.
Few GPs are even aware there is a process in place that attempts to look at the needs of the NHS, in terms of doctor and nurse workforce, and to publish plans to train the estimated number of clinicians needed. The problem is, we seem to be too busy dealing with the crisis to engage with a possible solution.
Currently SHAs are responsible for commissioning the required number of training places in both hospital specialties and general practice. But from April 2013, the responsibility for workforce planning will fall to Health Education England (HEE). The local branches of HEE will be called local education and training boards (LETBs) and will be organised to represent local medical interest in training by grouping NHS providers to help HEE fulfil its functions – so all providers must be represented on an LETB.
GPs are not well represented on LETBs at the moment, as this story shows, and there are two main reasons. First, when shadow boards were established it was unclear which organisations should be involved, especially for LMCs. In the past, LMCs haven't been involved with workforce planning as it fell to the deaneries, with national organisations such as the RCGPand the BMA providing guidance. Now funding for primary and secondary care workforces falls into the same pot and the deanery works for the LETB. Second, while LMCs hung back from joining the shadow boards, SHAs took the lead and wasted no time recruiting representatives for LETBs from the hospital trusts.
While my experience of LETBs has so far been good, I worry the system is vulnerable to tokenism. There is no current legislation to stimulate GP engagement in workforce planning, and if board members in one area decided to favour trusts over GPs there would be nothing to stop them doing so.
Where I work in Wessex, our LMC has established and maintained good relationships with other local NHS providers. So when the embryonic LETB was established, our group was approached and invited to become a member.
I turned up to the first meeting, which was dominated by the medical directors and chief executives of local hospital trusts, community providers and the mental health trust. I was the sole GP. The first question I was asked, by a hospital CEO whom I have known and respected for many years, was why I was there.
‘As GPs, we provide 90% of all the contacts with patients,' I replied. ‘So we are a major provider within the NHS despite receiving less than 8% of the budget.'
If general practice fails because of
poor workforce planning, I added, the rest of the NHS will fail as well. The LMC represents all GPs and practices who work as providers – it is not to be confused with the local CCG.
Boards without GP representation also
risk focusing on short-term staffing issues rather than a long-term strategy. Left unchecked, LETBs could also reduce, rather than increase, the number of funded places for training GPs.
GPs' key role
My LETB in Wessex will include two GP voting members out of a total of 16 – that is, about 13% of the board. There has been a guideline sent around the shadow boards that recommends around one board member in 10 should be a GP. HEE will publish a final copy of the document on its website later this month. To my mind, a goal of 15-20% representation seems a better aim.
The absence of GPs on an LETB either indicates that the organisation has failed to grasp the key role general practice has within the NHS, or – more concerning – demonstrates a deliberate attempt to keep general practice out of the decision-making process.
Dr Nigel Watson is a GP in Wessex, chief executive of Wessex LMCs and a GP adviser to the Centre for Workforce Intelligence
The views in this article are personal to Dr Watson and do not necessarily reflect the views of any organisation in which he has a role