This post is from The King's Fund Blog
There is a workforce crisis in general practice, with difficulties in attracting doctors to GP training and a shortage of qualified GPs. This comes at a time when demand for consultations is rising and there is a strategic goal to move more work from secondary to primary care. Yet funding for general practice has not kept pace with these changes.
I am a GP trainee, in my first year of a three-year training programme. Slightly unusually, I made the jump to general practice having spent five years as a hospital doctor, three of which were spent specialising in paediatrics. As part of my GP training I have been working at the Fund on a project that aims to provide an ongoing independent assessment of the key issues facing general practice, building on the Fund’s previous work in this area.
For this project we have used data provided by ResearchOne to allow us to analyse current activity levels in a sample of 202 general practices. Some headlines from this analysis appear in the Fund’s quarterly monitoring report, which already monitors NHS provider and commissioner finance and performance. We have also carried out a small online survey of GPs and practice managers – we received 129 responses, some of which may have been multiple respondents from the same practice – that provides a snapshot of the current financial, workforce, morale and organisational issues they are facing.
Our data analysis shows that demand for GP appointments is increasing, with a 6.1 per cent increase in the number of face-to-face contacts over the past two years within our sample – the vast majority of our survey respondents also reported an increase in demand. In those aged over 85, our data analysis revealed a 26 per cent increase in contacts.
Only a quarter of survey respondents said they were recruiting more clinical staff to manage this increase in demand, but this is hardly surprising given that 58 per cent of respondents said they were struggling to recruit salaried GPs and 50 per cent were having difficulty recruiting partners. In addition, 44 per cent said at least one partner in their practice was planning to retire in the next two years. Several respondents reported that newly qualified GPs seem to be opting for locum work, which is exacerbating the financial pressures on practices, while several practices said they were struggling to recruit even locum doctors.
It is important not to read too much into what is a very small sample. Nevertheless, these findings are concerning in the context of the debate about the sustainability of the current workforce. Certainly, among trainees I know, barely any want to work full time after fully qualifying, and many are planning to take on locum roles.
So why is this? Well, for one thing, being a GP is very different to being a hospital doctor. You work more as an individual, seeing patients by yourself, which is very different to the team-based approach in hospital, and you manage a higher degree of uncertainty. This is nothing new. What is new is that GP trainees are becoming aware of the extent of current pressures on qualified GPs, and the stress they are under: the increasing number of consultations taking place; the need to manage patients with complex conditions while also processing results and letters, all requiring careful attention to ensure you don’t miss an important result or action. Add to that the pressures for partners of having to deal with the practicalities of running a business, and it is easy to understand why working as a locum, or part-time, is more attractive than being a full-time GP or partner.
So, given all the workload pressure and stress, why do I want to be a GP? General practice offers such variety; in one morning you can see individuals – from babies to people in their 90s – with a whole range of acute and chronic conditions. As a GP you are usually a patient’s first port of call; you may decide that one of their symptoms warrants further investigation, and so refer them to a hospital specialist for support in diagnosis and/or management. But then you will also be there after a diagnosis is made, to continue to support them and monitor their whole health, not just one individual aspect. People place a huge amount of trust in their GP, and it is a privilege to be given a window into their lives.
The nature of health care is changing, with increased demand and people wanting better, quicker access to services. General practice must adapt to reflect these changes and to offer a good service to the population it serves. However, general practice should also be a satisfying and fulfilling career. GPs must be supported to manage the increasing level of demand and the subsequent pressures this causes.
General practice has always been at the heart of the NHS; to ensure its future, the onus is on policy-makers, health care leaders, GPs and trainees to develop a model of general practice that will meet the needs of both patients and workforce.