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The Crisis in General Practice

Blog by Dr Andy Mercer, Chair of the LMC's Western Sub-Committee

The Kings Fund wrote in July 2017 about the growing crisis in General Practice. Whilst patient satisfaction remains high – it is reducing steadily.  satisfaction of the experience of making an appointment and practice appointment systems has reduced significantly. The Government’s response to this has been to focus on trying to improve access – aiming for an 8am-8pm service by 2020. Some practices or groups of practices already offer this access but have not seen the increase in satisfaction expected. Even if capacity is increased,  workload in General Practice continues to escalate with the pressure on GPs increasing year on year. Kings Fund looked at Demand in General Practice and it was no surprise to see in the sample analyzed that GP workload had increased over a 4-year period in volume and complexity with a 15% increase in consultations and a growing number of patients with complex conditions. Over the same period the proportion of NHS funding spent on general practice declined by 0.4%.

With the aspiration to improve the wait times in the Emergency Departments, there is now a planned rollout of GP Triage in the Emergency Departments. Locally I think there will be a massive challenge to find enough GPs to staff these services. The relaxation of the 18-week – referral-to-treatment waiting times standard for elective treatment will also likely increase the workload for General Practice as people wait longer for operations or specialist input.

Despite the pledge to increase the number of doctors working in General Practice by 5,000 by 2020/21 the number of Full Time Equivalent (FTEs) GPs fell by 0.3% in 2016 We have seen from the work done by Prof. John Campbell and his team demonstrating that a large proportion of the workforce is over the age of 55 years and the workforce is likely to shrink (rather than expand) by 2020/21. Of those GPs in training less than a third plan to work full time one year after qualification, many intending to have portfolio careers – the main reason cited being the intensity of the working day in General Practice.

The GP Forward View (GPFV) was planned to provide a solution to allow sustainability of General Practice but I don’t think we have really seen any of the fruits of the billions promised providing the stability locally. I had hoped to be writing about the positive changes made to improve the stability of General Practice after the promises made when the GPFV was launched, but unfortunately, I cannot. In some areas of Devon, the crisis arrived months ago and practices are facing the stark reality that for them General Practice is not sustainable in its current model.

We look forward to the leaders in NHS England making the big decisions that need to be made soon and having the courage to take the steps to invest substantially in General Practice. NHS England working with the STPs and CCGs must work with General Practice to help reduce the workload and help make it a more attractive option for retention of the current workforce and an exciting opportunity for newly qualified GPs to commit their future to.

I see the building of a stable General Practice as the most urgent priority the Health Care System faces as without a sustainable General Practice the changes that are suggested to make Secondary Care more sustainable will not be able to progress.