It’s universally acknowledged that the UK has a shortage of GPs – as today’s news
Our ageing population with increasingly complex health needs has been coupled with a GP workforce that’s opting to work part-time – not least because the pressures on GPs have been too great over the past decade. There has been grossly inadequate support in the system for the increasing demands placed on our service.
Many patients will have put up with ailments that have been troubling them for months
Given this starting point – a workforce teetering on the edge of retirement or burnout – a shock to the system might be all that is needed to tip the service into a tailspin.
2020 has delivered just that. Who could have imagined at the start of this year that nearly every GP practice in the country would see a steep decline in patient demand, sustained for months, combined with the reduced footfall in A&E departments and urgent care centres? Add into the mix a cessation (or switch to virtual delivery) of other routine health services – physio, counselling, sexual health and podiatry, to name a few. And the final nail in the coffin – the suspension or delay of routine and urgent investigations, outpatient appointments, and surgery.
It can be no surprise, therefore, that there’s pent up demand, and need. Many patients will have put up with ailments that have been troubling them for months. Quite reasonably, they now need help.
Patients with chronic physical and mental health conditions, normally under the care of primary or secondary care services, have had to manage their health themselves. A good number of these patients cannot cope without the support they ordinarily receive. And so many will deteriorate, run into complications, perhaps even die. We should not be surprised by the excess mortality we will see over this year (and into the next).
The result of the year we have had (in terms of secondary care service provision, wider health service accessibility, and patient willingness to seek health advice), is that we should now expect a huge, unforeseen, surge in demand.
In recent weeks, GPs are beginning to report unexpectedly high levels of demand. After all, the GP will be your first port of call to discuss your niggling problems, delayed operation, worrying new symptom, or ongoing need for pain relief. This is our role. When children are back at school, and the winter respiratory viruses are circulating, our capacity is going to be totally overwhelmed. The result of this sort of workforce-demand mismatch will be missed diagnoses, increased secondary care referrals, long waits for appointments, overprescribing and A&E attendance; to name a few. GP capacity is essential to keep the entire system afloat.
If NHS England really wants to support practices, they should suspend the PCN DES and look urgently at how to offer the additional roles reimbursement to GPs and advanced nurse practitioners. Prior to Covid-19, as part of a workforce project, I undertook a survey of 400 GPs working six or fewer sessions. I found that 36% of these would take on additional clinical session weekly if it were offered with the same conditions as extended hours (prebookable, no workflow or pathology, visits or duty). A further 28% would take on this sort of session fortnightly.
The sticking point for most GPs in taking up extra sessions is the intensity of their work schedules. So, I proposed a scheme where GPs could take up a protected extra session – consulting with 12 patients, at a flexible time, in hours. They would be protected from additional work besides direct consultation. The idea was to make the extra session so appealing that GPs wouldn’t be able to turn down the opportunity. Many places find that the extended hours sessions are popular, and easy to fill. So, it makes sense to recreate these conditions to incentivise GPs to take on extra clinical work in hours.
Extrapolated across the workforce, this scheme would produce 1,136 extra FTE GPs. It’s not 6,000, but it would help the system to cope. Imagine this winter, if every GP practice had an additional GP session taking place on most days. The relief valve that this could offer…
It’s easy to feel disheartened and disillusioned with NHSE. To have the sense that they’re pursuing their agenda, with little thought or consideration toward GPs on the ground, who have to manage with whatever comes their way. Nevertheless, it’s in the gift of NHSE to rescue or shipwreck our service, especially at times like these.
Matt Hancock needs to realise that for every penny spent on a Nightingale Hospital or the Test and Trace service, the money would be many times more well invested in supporting GPs working in their own surgeries. A tsunami is coming towards the health service, and we need to be preparing for it.
Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West