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2016: too much conversation and not enough action

It is a tradition of mine to look through the year’s issues of Pulse as we prepare our December edition. It is always a reflective experience, but even more so this year because so much has happened in 2016.

Funding is harder to find than a politician who understands Brexit

We began the year with the heat and fire of the first Special LMCs Conference since 2003.

Pulse had just released figures showing the number of practice closures was running at a record high. The anger of delegates was palpable as they voted to consider submitting undated resignation letters if a credible rescue plan was not forthcoming. ‘If not now, then when?’ was the salient message from the meeting.

The counter offer came in April. NHS England attempted to douse the flames of radicalism, with its GP Forward View promising an additional investment of £2.4bn into general practice by 2020. The magnitude of this pledge caught many by surprise, I certainly read it with a sharp intake of breath, but it was a bit like a promise to make amends in future from a cheating spouse.

‘I’ve changed!’ cried NHS England, with its arms flung wide. ‘I’ll believe that when I see it,’ responded most GPs (except – famously – the RCGP).

The sense of betrayal deepened in August, with the GPC’s decision not to explore any options for industrial action, after a letter from NHS England containing yet more promises. It felt to many GPs a bit like their supposed best friend had just shacked up with the aforementioned cheating spouse and they were now left out in the cold (apologies for the strained metaphor).

Eight months on from the forward view, GPs have seen little improvement. If anything, things have got worse. The promise of a ‘turnaround’ for the profession has yet to materialise. An NHS England director asked me recently whether Pulse would stop being so negative about the measures managers are taking. I shook my head and said: ‘Not until GPs feel a change on the ground.’ Our survey results released today show things are going backwards.

To give NHS England credit, cash has been released for a much-needed GP counselling service and a scheme to help protect GPs from spiralling indemnity costs.The above-inflation pay rise in April was welcome, and timely.

But as Pulse has reported, so-called ‘resilience’ funding is harder to find than a politician who understands Brexit. The resignations of partners and the closures of practices continue. We may have a few hundred more trainees this year, but practices are still struggling desperately to recruit. The years of underfunding, coupled with more recent cuts to PMS or MPIG and soaring workload, are making life impossible.

It feels a bit like NHS England has ticked a box and then moved on to more pressing matters – like the crisis in acute trust finances, or its ‘sustainability’ revolution, which mainly involves shutting hospitals and shifting yet more work onto the shoulders of GPs.

And the strength of feeling grows – just look at the plans being prepared by LMCs in some areas, which include the radical step of taking GPs outside the health service.

But let’s be clear – most of the GPs I meet greatly value the health service, but they have fallen out of love with the system they have to work in. These moves are born of desperation, rather than a desire to trash the NHS. 

Yes, 2016 has been a remarkable year for the profession. But if nothing concrete changes in the months ahead, then 2017 may mark a watershed.

Nigel Praities is editor of Pulse