Today’s results from GPC’s survey of GP practices in England into their attitudes toward closing their practice list demonstrates the incredible, mounting pressure that on a daily basis our profession is now dealing with. It provides the clearest indication yet that politicians need to put their words into action and rapidly deliver tangible change that will resolve this growing crisis.
The picture painted by this poll will be familiar to anyone working in a GP practice. Day after day most surgeries will find themselves preparing for a stressful, pressurised day with a full waiting room, the phone ringing constantly for appointments that there is not the capacity to deliver and a long procession of complicated consultations that often have no easy solution.
This is merely the immediate, direct problems that many GP services face but there are many more ongoing issues that add to the stress and difficulty delivering acceptable services to our patients. Spiralling indemnity costs have left countless GPs worried about how they are going to cover the costs in the future, with many fearful of the impact this will have on their ability to do out of hours sessions. The building, thanks to the patchy implementation of the Estates and Technology Transformation Fund, may still be dilapidated or too small to deliver services effectively. GP, nursing and other staff shortages continue to beset many practices with recent BMA surveys backing up the anecdotes I have heard constantly from GPs: a third of GP practices have had vacancies left unfilled for a year while nine out of ten say their workload is unmanageable. It’s no wonder therefore that so many GPs I speak too are worried that they are reaching a stage where patient safety is close to being compromised.
In this climate, it’s hardly surprising that over half of GP practices responding to our survey now say they would consider temporarily closing their practice lists and four out of ten would take the even more serious step of applying for a full list closure from NHS England. This cannot be anything other than a clear warning signal of how desperate the situation now is. For even a single surgery to be considering this move – and many of course have already taken this step – is evidence of a failure of current policies.
Through consistent pressure from GPC, in the past couple of years there have been signs that politicians and NHS managers are waking up the fact that the crisis we have been warning about is a reality and must be dealt with. We’ve successful scrapped the Avoiding Unplanned Admissions DES, achieved full reimbursement for CQC payments, and secured investment for guaranteed sickness payments, in year indemnity rises and other practice expenses. There is more support being offered by pharmacists in some areas and the whole of England is now covered by the sadly much needed GP Health Service. However this is only scratching at the surface of what needs to be done.
As I begin as GPC chair I am conscious that while the argument has to an extent been won, the delivery and implementation has been left wanting. Promises of extra GPs have not been delivered and the promised funding increases have been nowhere near enough to address the fundamental problems. Practices on the edge may have received some resilience support but all too often it’s been too little and too late.
As this new survey underlines, general practice is continuing to slide further into crisis. What GP services need as we head into winter is for the government to find some urgency. A comprehensive drive to address workload pressures, deal with the indemnity crisis, step up recruitment and retention initiatives and deliver the promised extra funding has now to take place right across the country. Without it we’ll see practices not only have to close their lists for patient safety reasons, but more and more practices could well close altogether, with major implications for the rest of the NHS.
The time for warm words has long been over. Politicians must take this survey as a clear, serious warning from those who know the most about what it is really like to work in local GP service. Promises must be put into action before irreversible damage is done to the fabric of general practice.
Dr Richard Vautrey is chair of the BMA’s GP Committee, and is a GP in Leeds