There’s an Indian saying that means ‘It will be useless to hold a person for anything that he says while he is drunk, running for office or in love’.
It strikes me as particularly relevant right about now.
In his maiden speech to Parliament after being appointed Prime Minister last week, Boris Johnson said: ‘I am committed to making sure that the NHS receives the funds that were promised… This will include urgent funding for 20 hospital upgrades and winter-readiness. I have asked officials to provide policy proposals for drastically reducing waiting times and for GP appointments… We will fix the crisis for social care once and for all with a plan we have prepared.’
But ambitions only come to fruition if paired with detail, and, alas, there was little here. Like his predecessors, Johnson is totally out of touch with reality and gazing in fantasy land.
We don’t yet know what his announcement of 20 hospital upgrades will entail. Johnson has recommitted that his Government will honour the £20 billion in additional funding pledged by Theresa May. However, it’s debatable whether even this additional funding increase is sufficient, and it doesn’t include money for areas like public health and workforce training, which will be critical to improving service quality.
Let’s examine his fantasy pledge to reduce GP waiting times. NHS Digital figures on the number of registered patients per GP and and CCG show a 6% increase in patients per GP across England between 2016 and 2018. This averages 2,176 patients per GP in 2018, up from 2,053 two years prior.
Furthermore, 13 CCGs have seen increases of between 15% and 24% in patients per GP in this period. They include Swale, South Coastal Kent, Swindon, Norwich, Southwark and Southend.
Obviously, there are two things going on – a population increase, and fall in GPs.
We’ve been squeezing the lemon for all sorts of healthcare needs for years, but it’s getting to the stage where there’s nothing left to squeeze
In England, we have lost more than 700 full-time equivalent GPs since 2015, despite pledges from the Government to increase numbers by 5,000 by 2020. Does Mr Johnson realise that leaving the EU with no deal has far-reaching implications for general practice? I somehow doubt it.
A large proportion of the workforce consists of non-UK qualified GPs – over a fifth is from the EEA and elsewhere – and research demonstrates that these GPs tend to work longer hours, are older and serve more deprived areas than their UK-born counterparts. Brexit with no deal, or indeed a hard Brexit, would exaggerate the recruitment and retention crisis and threaten the delivery of care, particularly in deprived areas.
NHS Digital statistics show that since the referendum, the number of foreign EU nationals joining the NHS has plummeted from 2,500 to 200 a quarter. As for those already here, research by the BMA has found that more than a third of EU doctors are already considering leaving the UK, with Brexit being the overriding factor. Many GPs I meet tell me that they have stopped working out of hours and extra shifts to avoid huge pension tax bills, meaning already overstretched surgeries have fewer appointments to offer patients.
Mr Johnson, do you know that the NHS has the most stressed GPs by Western standards, as a result of relentless workloads, endless bureaucracy and the shortest amounts of time spent with patients? We have been squeezing the lemon for all sorts of healthcare needs for years. But it’s getting to the stage where there is nothing left to squeeze. Primary care is imploding faster than people realise, and patients are already bearing the brunt of the problem.
Already, 5% of patients have to wait for a month to see their GP, or not getting an appointment at all, while thousands of patients wait for hours in A&E and on hospital trolleys.
General practice has never been in a more dangerous position than its current one, and the decline of our great profession will only be accelerated by Johnson. The gap between policy rhetoric and reality has never been starker, and pledging to reduce waiting times to see GPs is neither credible nor practical. So, the Prime Minister needs to forget about political gimmicks and focus on understanding and addressing these pressures.
I’m not alone in urging him to get real about how to properly resource and rebuild primary care.
Dr Kailash Chand OBE is a retired GP in Tameside