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No bargain, Hunt



The subtext to Mr Hunt’s spin-laden bilge is clear: he believes GPs are a group of whining irritants he needs to knock into shape.

Setting aside the hollow flattery of comments early in his speech – best in the world, jewel in the crown, top scores for quality – he has offered precisely nothing to reassure the GP workforce that he’s battling burnout.

With the sincerity of Flashman, he mentioned how we may feel undervalued, underinvested, undermined.  What followed will leave more GPs underwhelmed, under the cosh, or moving Down Under. 

Workforce: He’s replacing 10,000 retiring GPs with 5,000 new ones. That’s a net drop of 5,000.  He’s training up 1,000 physician associates to help the shortfall. That’s the clinicians with just two years of medical training and the need for close GP supervision. At £30-40,000 a year, they cost less than a GP, but it’s a false economy. Our work rate and consultation speed is three to four times faster and we work independently.

Recruitment: There are an extra 300 medical students choosing GP, but there are thousands more medical students. Over 50 GPs have been enticed back under the ‘returner scheme,’ but we’ll need to encourage 100 times that number back by 2020 to get staffing levels back to where they are now. 

Seven-day opening: It’s conceivable, of course, that a lack of access to GP records at weekends may increase admissions. Out-of-hours GPs are more risk-averse, so why trouble your defence union rather than send the patient in?  But let’s not pretend that patients will be seeing their own GP under this deal. Locums will still do the work, which does not and will not reduce admissions. 

The £10 million payout: Investment? In general practice? Surely not! No, in fact: definitely not.  The lump sum will provide “advice and turnaround support” for failing practices and “help for the practice to work with others to change its business model”. This is code for “pay a management consultant a large fee to overhaul a once proud and thriving NHS care provider”. 

Rising demand: Obsessed with easy access, this Government has created a juicy beast: the tweeting generation, buoyed by telephone triage and telemedicine, swarm to us with minor illness and suck the lifeblood from a dying animal. “Surveys”, “practical tools” and “workshops” to “reduce bureaucratic burdens” won’t help GPs, and any time saved will be dedicated to yet more clinical work. No respite there then.  

Social prescriptions: (I’ve saved the best bit ‘til last). “Social prescribing [will become] as normal a part of your job as medical prescribing is today,” Mr Hunt says. GPs will be empowered to deliver an even bigger role in public health. In other words, let’s integrate social and medical care to make a significant cost saving, then dump it all under a primary care umbrella.

Forget all our efforts to rationalise prescribing, achieve QOF targets, deliver enhanced services, train GPs, write reports for the DWP and give continuity of care: we’ll now provide financial advice to the debt-laden, friendship to the lonely, care packages for the elderly, jobs for the unemployed and a dating service for the broken-hearted.

All this with less doctors, no funding and rising demand, seven days a week.   

Dr Tom Gillham is a GP in Hertfordshire and specialty doctor in A&E. You can follow him @tjgillham.