If general practice fails, the NHS fails
By Dr Kim Nurse
ST3 GP trainee and FMLM Trainee Steering Group representative for London
As an ST3 in a busy South London practice, I am fully aware that, at present, I am well protected from the inordinate pressures on primary care. However, as I talk to other ST3 colleagues, the future of primary care and the reality of working as a GP is a daunting prospect in the current climate and there is a dearth of positive news to alter that view.
Last month, I made my way to Liverpool to the Royal College of General Practitioners (RCGP) Annual Conference, for what I hoped would be two days of inspiring talks to get us back on track.
It was a poignant start to the conference when Professor Martin Marshall, RCGP Chair, read out the names of every GP who had sadly lost their life to Covid-19 and a timely reminder of how hard GPs have worked and the sacrifices all those on the front line have made since this pandemic began.
Professor Chris Whitty, Chief Medical Officer for England, who has faced more challenges than most in the past two years, spoke next, and presented the epitome of authentic leadership. Having made an eight-hour round trip to attend the conference, he praised GPs for their response throughout the pandemic and acknowledged that without their hard work, the situation would be catastrophically worse. He also remarked on the current criticism faced by GPs, advising: “Never worry about criticism from someone you wouldn’t take advice from”.
Professor Whitty talked of GPs having led the biggest mass vaccination programme on record in the UK, an achievement seldom recognised in the media. He described how all those in health and social care face a difficult winter and the ongoing challenges of finding a balance between face to face and remote consultations. He received a standing ovation from all delegates in the hall; clearly an emotional moment for many, including Professor Whitty himself.
The day the conference opened, a new primary care funding package of £250 million had been announced. As Dr Becks Fisher, GP and Senior Policy Fellow at the Health Foundation, remarked: “Is £250 million going to fix the problem? No because you cannot buy what is not available”.
Prior to the Covid 19 pandemic, it was estimated that general practice was handling 300 million patient consultations each year, compared to 23 million visits to A&E. Funding for hospitals has been growing twice as fast compared to general practice, yet two A&E visits cost, on average, more than a year’s worth of GP care per patient.[1] .
The number of patients per GP is now 22 per cent higher than it was in 2015 and there are simply not enough GPs to meet demand. In 2015, the NHS Five Year Forward View proffered a vision of a better health service, along with recognition that this would need 5,000 more GPs by 2020. However, by March 2021 and following the impact of the pandemic, there were 1307 fewer GPs than in 2015, prompting the King’s Fund to warn of a profession “in crisis because of difficulties in recruiting and retaining GPs alongside a growing and increasingly complex workload”.[2]
Dr Fisher also highlighted the stark health inequalities made worse by the ‘inverse care law’, where practices in areas of high deprivation have a higher population health need and have higher consultation rates, yet receive less funding, have fewer GPs, but turnover is higher.
Including Covid appointments, in August 2021 GPs delivered two million more appointments than in August 2019. The diminishing number of GPs and growing number of patients means GPs are working harder than ever, which is taking its toll on an increasingly overstretched workforce.
The government has committed to an additional 6000 GPs by 2024. But finding them – and in time – is another matter.
In the words of Dr Nikki Kanani, GP and Medical Director of Primary Care at NHS England, “there is no silver bullet” but it is clear system reform is needed. Dr Fisher also warned, “if General Practice fails, the NHS fails”, so as GPs we need to be part of the solution.
I left the RCGP conference grateful for those leaders at the forefront of primary care who are working to change the system but was struck by the importance of clinical leadership and its urgency having never been more apparent.
I, along with many other colleagues, are now looking to Leaders in Healthcare next week to continue this crucial debate.
[1] Next Steps on The NHS Five Year Forward View (March 2017), NHS England, accessed from https://www.england.nhs.uk/wp-content/uploads/2017/03/NEXT-STEPS-ON-THE-...
[2] General Practice: our position (22 October 2020), The King’s Fund, accessed from https://www.kingsfund.org.uk/projects/positions/general-practice