The UK election saw a focus on general practice that was unlike any previous campaign in modern times. Sadly all the parties were unified in their failure to acknowledge the crisis facing GP services, which have become an under-resourced, over-stretched shell of their former self, struggling to keep pace with patient demand despite the efforts of their staff. This mismatch between reality and politicians’ promises is a real threat to patient services in the years ahead.
The problems facing GP practices are all around us. A foundation trust in Derbyshire has been made “emergency caretaker” of three GP practices facing recruitment and financial problems, as two others in the area face closure. There are now 7,962 GP practices in England – one in 20 has disappeared since 2010. The rate of loss of local surgeries has speeded up – 79 closed and 55 opened in 2010 but in 2013, 126 closed and only 13 opened. There has been a five-fold rise in the number of GP surgeries approaching senior NHS managers for advice about shutting their doors or merging with nearby practices.
Meanwhile, a recent British Medical Association (BMA) survey of more than 15,000 GPs found that 93% feel their workload was negatively affecting patient care, while a third were considering leaving the profession as a result in next five years.The Royal College of General Practice last year warned that more than 1,000 GPs will be leaving the profession each year by 2022.
I could, of course, go on with more figures to illustrate what GPs on the ground are telling me: they are having to work hard on shrinking resources just to keep up with the pace of expectations from patients. This is why the prime minister’s announcement this week of seven-day services is being met with cynicism by many in the NHS.
GPs will tell you that they are perplexed as to how they are supposed to provide this service when they can’t even provide enough appointments during a standard working day. The promise of thousands of new GPs not only ignores the fact that the pressures of being a GP are putting medical graduates off joining the profession, but also that it takes a good eight to 10 years to train. Practically, its not possible to pull so many GPs out of the hat. Despite all this, the prime minster talks of more care in primary care, more access, initiatives and ideas – ignoring the workforce crisis, a funding disaster and the committed GPs facing burn out.
We all want a patient-focused NHS, but this comes at a cost. Supermarkets and banks can increase their income streams by making their services more attractive to customers, but the NHS works within a fixed budget and cannot attract more revenue by changing its availability to the public. Longer routine work will mean more costs — there is only so much that can be achieved by efficiency savings and these are being already squeezed out to unprecedented levels. Delivering more, without further funding, is not possible or desirable.
The new government needs a reality check and needs to understand that what GP services need is a long-term, stable plan that gets them back on an even keel. This means better funding and a sensible recruitment plan, and also a wide-ranging look at how we can support new services in general practice and release the experience and potential that GPs and patients have to shape services locally. While there are some examples of good practice, many clinical commissioning groups have failed to make this happen.
General practice is the bedrock of many NHS services and the gatekeeper to the rest. We can either confront the realities facing GP practices and make plans now to meet growing challenges – or we can bury our heads in the sand and watch this key part of the NHS slide into permanent decline.
The reappointed health secretary, Jeremy Hunt, has said that “GPs are absolutely central to my vision of the NHS”. The BMA has called on the new government to “restore investment” in general practice as one of six priorities. Rather than political gimmickry, he needs to focus on addressing the pressures facing GP services, so that we can retain the current workforce and attract young doctors to general practice.
