NHS England’s Dr Amanda Doyle on how the long-awaited workforce plan aims to change general practice over the next 15 years
It is not news to Pulse readers that GPs and their teams are treating record numbers, with half a million more appointments delivered every week compared with before the pandemic.
We also know this demand is going to increase further still with the number of people in England aged 70 or over increasing by a third since 2010 and they are five times more likely to need a GP appointment than young people.
So, it’s important to ensure that the NHS has a workforce that can meet this demand.
But we know we do not have enough GPs – it is what I hear time and time again when I visit practices across the country, I also know that the workload impact of too few GPs is why many of you are considering leaving the profession.
The NHS Long Term Workforce Plan looks to change that with a commitment to increase the number of speciality GP training places by 50%.
This means 5,000 people will be taking up speciality training places by September 2028, up a quarter on current levels.
All foundation doctors will also have at least one four-month placement in general practice by 2030/31, and GPs in training will be able to spend three full years of their training in primary care settings.
The plan also recognises that retention of experienced staff is critical and offers a greater emphasis on occupational health and well being services for all NHS and General Practice staff.
As the NHS has done throughout its 75-year history, it must evolve to reflect the current needs of patients.
Research shows that around one in five GP appointments are for non-medical reasons, so we need to make sure that these patients are accessing the right health professional and if necessary, are redirected to the right service elsewhere.
Some of that is about continuing to expand the primary care workforce and progress by PCNs has already been made with over 29,000 extra staff being recruited to GP teams since 2019 – meaning patients can receive specialist advice from other clinicians, such as mental health practitioners, social prescribers, and pharmacists.
The plan will ensure even more patients can be seen through this route with an extra 15,000 patient care staff and 5,000 more nurses joining GP teams by 2036/37.
We also know that we cannot train more GPs and increase our workforce to meet demand without ensuring that we have the estates and infrastructure to support these staff and this plan recognises this and commits to addressing the issue.
All of the above is going to take time and will not change general practice overnight, but I am confident that this plan will help to make primary care more sustainable and a better place to work and be treated over the next 15 years.
Dr Amanda Doyle is national director for primary care and community services at NHS England
Dear Amanda,
if you wants GPs to stay, there are three things you could do immediately which would cost nothing, in fact save lots of money, and free up thousands of GP hours:
1) suspend appraisal and revalidation- it has no proven benefit, costs a fortune and wastes vast amounts of GP time
2) suspend all routine CQC inspections, focus only on high risk practices and practices that complaints have been received about. Inspecting every practice for no reason wastes vast amounts of GP time that could be used to see patients
3) Properly tackle secondary care dumping their work on to primary care. There needs to be a serious, zero tolerance approach with financial penalties for trusts that break this. This work wastes huge amounts of GP time doing secondary care work for them for free.
Have we got the sufficient NHS Estate for this workforce to work from?
Or is this another wasteful Paper exercise dreamt by Management Consultants costing Millions of pounds where they demonstrate how to put the Horse before the cart.
If I was government / NHS England I would suggest we already have enough space if we move to 6 day access, 12 hours a day.
Then 3x 4 hours sessions per day, 6 days covered by 2 trainees in a single room (each session 3h patients, 1h admin / break).
It’s the obvious way I can see to dramatically increase training capacity for Students, F2, Registrars.
Visits / Care homes by network teams (including trainees).
Would need money to make me WANT to switch to this, but I think lots of ways we could innovate if there were the right financial incentives, and likely cheaper than a huge GP building program.
Focussing upon the ‘gatekeeper’ prior to seeing a clinician (receptionist function) may have some limited potential.
Direct patients to what may be the most appropriate service initially may allow some non-medical issues to be diverted away from health facilities thereby reducing the waste of clinical resources, reducing disagreements/arguments and possibly reducing the need to grow the estate (if they are directed away from the health centre).
This has been compounded by
1. Patients manipulating to get what they think that they may benefit from
2. Triage inefficiencies due to incorrectly directed patients needing to be reintroduced elsewhere in to the system
3. Risk of incidents due to incorrectly directing patients leading to adverse outcomes
4. Patients declining to reveal details to non-clinicians (and sometimes making complaints about being asked). Perhaps the robots mentioned elsewhere in the news may get past that (bizarrely patients may be more prepared to disclose to a robot rather than a human with a contractual requirement to maintain confidentiality).
It would involve giving up a degree of control over the reception which many GPs quite reasonably would be anxious to do. Fear of driving up demand, risk related to actions of the reception service, etc. Cooperative action between GPs to influence the service whilst insisting the hassle / risk sits outside individual practices could be an option.
Maximising efficiencies with triage seem to be one of the limited options to manage demand left. Previous forms of rate control have been undermined or refused.
1. Reception dragons 2. Sitting and waiting in long queues 3. 0800 rush for appointments 4. Long Waiting lists to see GP 5. Charging / copayments
However, 30+ years as a doctor tells me that any increasing supply of clinical delivery will still be outmatched by increased demand without some form of rate control through inconvenience or charging. Any suggested savings from primary prevention fail to consider the costs of the prevention itself alongside the deferred costs as patients merely survive to ages requiring more complex care.
I am confident you wont be in post when this Yankee BS hits the fan Dr Doyle.
I very much doubt the plans will work. Every successive health minister has been promising for years now that they will miraculously conjure up more GPs but this never happens
The workload is unsustainable – this is why people are leaving
As mentioned by a previous contributor, Apprasials is pointless time wasting process. Same applies to CQC inspections (which should become more targeted)
GMC’s behaviour towards doctors also makes the profession behave in a way that generates more secondary care referrals
ARRS roles actually create more work with experienced trained staff frequently moving to greener pastures (for more money)
NHS England also needs to stop handing out giving out more and more unachievable work onto our already overflowing plates.
All together now——–”and the band played believe if you like”
Just had a quick overview of other previous plans; gp forward view published 2014. Sensible but lack of committed imprelmentation. Nhs plan 2020; similar to the current one and soon forgotten. I’m sure this will be the same. An uncosted plan is not a plan. It’s is wishful thinking. The £2.5 billion funding for this over 5 years although trumpeted as new will as usual need to be found from existing efficiency or undespends eg ARRS etc. Increasing recruitment but failing to retain experience will be a disaster for the increased training needs needed to implement this plan. In addition, the elephant in the room is funding. Where is actual costing for the increase in doctor numbers (assuming they can be retained)? Is this going to be within the same current 8% share of the NHS budget handout given to primary care currently or is the envelope going to be increased (never happened in the last 30 years at the expense of secondary care) ? If so that means increased numbers aims to drive down pay and why would anyone do the job as it currently stands and with the level of stress and responsibilities for reduced equivalent pay? There is nothing in this plan on how to make general practice a sustainable worthwhile career focused on safety and quality rather than quantity and bums on seats. Yes we need more doctors and nurses but we also need limitation of expectations and a workload cap, more time to manage patients (10 minute appointments should be confined to the bin) reduced beaurocracy( eg appraisals and Revalidation, mandatory training diktats), workable basic IT never mind AI, better estates planning (to accommodate the expansion and Current crumbling infrastructure) and a lot lot more. This is more top down ivory tower rubbish with a complete failure to understand or consult with the profession on what is needed.
spot on neo 99 !
This plan is just words, no costing, no thought of retention, no thought of whats going to happen as the consequences of repetaed infections with Covid comes down the line- diabetes, heart disease, sick kids, autoimmune diseases to name but a few.
Its not going to happen, its not supposed to happen, just like all the other plans, its just for vote winning and then it will be quietly dropped.
Do you see any patients Dr Doyle?
No, thought not.
David Turner, your suggestion is far too sensible and realistic for NHSE to consider. It also lacks buzzwords like digital, inclusive, reaching out, above and beyond, and other nonsense without which they seem to be unable to function.
Based on previous experience, I have complete faith in the NHSE revolving door chain of command …
Dr Doyle appears to have no practical concept of the world of General Practice in my opinion and seems to be unable to relate to the profession hence we need a change at the top with immediate effect
Which is why she got the job.
‘OBE’ apparently.
Wonder why.
Chat Gpt – what is ‘The Fatal Conceit’?
“The Fatal Conceit” is a book by Friedrich Hayek that criticizes the idea that humans can possess enough knowledge to effectively plan and control an entire economy. Hayek argues against socialism and central planning, asserting that the complexity of economic systems and the spontaneous order that arises from individual actions make centralized control inefficient and harmful. He emphasizes the importance of decentralized decision-making and the market’s ability to coordinate economic activities. The book highlights the dangers of disregarding individual liberty and the unintended consequences of attempting to replace the market with central planning.