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How Hunt’s admission of failure on GP numbers could harm practices

Health secretary Jeremy Hunt’s admission that it would be a ‘struggle’ to recruit 5,000 new GPs may not be a surprise, but it could have significant ramifications for practices.

He didn’t go as far as to ditch the pledge – explicitly saying that he was still working towards it – but his interview with the Guardian is at the very least a back down.

The announcement shows Mr Hunt is facing up to reality: as Pulse has reported, we’ve lost more than 1,000 full-time equivalent GPs since he made the pledge in September 2015, meaning he needs to boost numbers by more than 6,000 in two years.

Now, he is making the first steps towards distancing himself from the target.

‘We do need 5,000 more GPs and we are struggling to deliver that pledge, but I’m absolutely determined to do so because GPs are working incredibly hard; too hard,’ he told the Guardian.

‘I got quite widely ridiculed when I made the pledge in 2015. I wanted to nail my colours to the mast of getting more GPs into the system. But it has been harder than we thought.

‘This is not a pledge that we’re abandoning because it’s a very, very important pledge for the NHS and with general practice. It’s just taking a bit longer than I had hoped.’

In other words: we’re not abandoning the pledge, but don’t expect us to fulfil it.

It has been harder than we thought

Jeremy Hunt

This is not good news for GPs. While the target was still live, we saw NHS England going all out to try and fulfil it. The move to recruit up to 3,000 overseas GPs was desperate, but that doesn’t mean it wasn’t helpful.

Yet there is little sign that they will be successful in this. At last count, there were only 85 overseas GPs working in practices, and these were only in the pilot areas – which were already being successfully led by GPs. NHS England promise there will be more by September, but this relies on overseas GPs actually wanting to come to England.

Other measures to increase numbers are well-intentioned, but are doing very little to the overall numbers. NHS England is ploughing £10m more into the retainer scheme to keep GPs in the profession. There are also more graduates than ever entering GP training.

But these are only small victories. The retainer scheme persuaded 250 GPs to stay in the profession last year – which is great, but will hardly save the profession. And we still don’t know how many of the record trainee numbers stay in the profession – incredibly, there is no widescale collection of data into this.

Following Hunt’s announcement, the political pressure to escalate these measures – however limited – might be taken off.

What we may see, in that case, is a focus on an area where NHS England has been much more successful: recruiting non-GP staff.

The GP Forward View sets a target of 10,000 new primary care staff: 5,000 new GPs and 5,000 non-GP clinical staff. As NHS England are keen to point out, they have almost hit their target on the wider workforce. There’s been an increase of 4,484 non-GP health professionals working in general practice from September 2015, against a target of 5,000 by September 2020. This fits into the agenda to work in larger practices, with the GP working within multi-disciplinary teams – and it will surely be only a matter of time before the Government and health managers increase the number they are targeting.

The process to secure funding for pharmacists is often laborious

BMA review of the GP Forward View

In some ways, these non-GP health professionals can be a great help. The 1,100 clinical pharmacists recruited, for example, are helping practices. Indeed, in Northern Ireland, the BMA says that they are ‘seen as an important first step in securing the future of high-quality GP-led services’. There are problems with recruiting clinical pharmacists – the BMA says ‘the process to secure funding is often laborious’ – but when recruited, they are an asset.

The same is true for mental health professionals. An increase in these numbers is of great help to practices. Yet there are problems with NHS England’s pledge for 3,000 additional therapists working in primary care. The BMA points out that these therapists are employed by IAPT services, not by practices, only some of these new practitioners will work in practices. Its survey of LMCs found that few practices report genuine access to these new therapists.

But there are other healthcare staff that are a bit more controversial – and these are the professionals that the Government will find more easily. For example, the Government is supporting universities to educate more physician associates. The target at the moment is 1,000 to work in general practice, but with lower training costs, this might be a cheaper alternative to GPs in the future. Unlike pharmacists and mental health therapists – who bring unique skills to the practice – a physician associate will be taking on GPs’ roles, just with less training and education.

We are still waiting for NHS England and the Government’s response to Mr Hunt’s admission. Neither have had anything to add to these comments. But they are a watershed. And it won’t be a surprise to see the rhetoric change in coming months to emphasise the 10,000 new practice staff figure – the vast majority of whom will be taking on GPs’ work without GPs’ skills.