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The Weekly paper of the New Communist Party of Britain

The GP Crisis

by New Worker correspondent

The British Medical Association (BMA), one of Britain’s grandest trade unions, has drawn attention to the fact that at a time of growing waiting lists in the NHS that there is also what Mark Steggles, a GP in the Buckinghamshire village of Burnham and BMA committee chair, calls an “absurd GP unemployment crisis, with thousands of GPs struggling to find work in NHS general practice” across England.

He complains that despite demand being at the highest levels ever there is increased competition for both salaried and partnership opportunities in the NHS, and that temporary locum posts have also been drastically reduced.

The union complains that a recent announcement by new Health Secretary of an extra £82 million for Primary Care Networks (PCNs, groups of GP practices working with community, mental health, social care, and pharmacies) to recruit more GPs, although welcome, is not enough. This injection of cash came through the Additional Roles Reimbursement (ARR) which was established in April 2019 and had previously explicitly excluded GPs, being used to finance extra allied health professionals such as radiologists and podiatrists.

According to the BMA funding for employing GPs has fallen by 12 per cent since 2019. The extra funding will benefit some newly qualified GPs, but it only “presents yet another temporary sticking plaster fix, attempting to partially treat the symptom that is GP unemployment, without directly tackling the underlying causes”.

This is due to inadequate ongoing training for young GPs who are often thrown into the deep end and have no time for career development unlike previous years.

Training a GP costs around half a million pounds, and without proper retention support, this is likely to go down the pan if graduates emigrate or take up running pubs. The financial cost to the public purse for losing and replacing a single experienced NHS GP has been estimated at least £300,000.

This “unemployment crisis” comes at a time when English GPs have to care for 17 per cent more patients than in 2015. The average GP has more than 2,300 patients, a rise of nearly 350 since 2015. Despite a growing and ageing population, the number of permanent GPs, excluding locums and trainees, is over 1,557 lower now, at 27,193 full-time equivalents, in the same period.

All averages hide the best and the worst. Some GPs serve 3,000 patients, double the best served areas. Most of the country has between 2,000 and 2,500 patients per GP. This is not the normal north-south division. Clusters around London and the south east and in the north west and Lincolnshire have the worst ratios of up to 3,000. The most fortunate is The Wirral in the north-west with 1,818 and the highest is Thurrock in Essex at 3,431, with Leicester close behind on 3,262. Needless to say the poorest areas are worse served. The latest figures are very slightly better than last year, but you need a magnifying glass to notice the difference.

Government plans to train more doctors and relieve some of the pressure by giving pharmacists more responsibilities has not gone down well with the BMA. The BMA says a rapid expansion would come at the expense of quality. While pharmacists have already taken on responsibility for minor ailments such as sore throats and shingles, handing out pills tends not to involve a consultation about what might be a serious underlying condition.

The Royal College of General Practitioners’ (RCGP) Chair Kamila Hawthorne has said that GP shortages are having a “devastating” impact on the health of local populations and the rise in the number of patients per GP has become unmanageable. Dr Becks Fisher, from the Nuffield Trust health think tank, has said funding needs to be targeted at those areas with the worst shortages.

The patient watchdog Healthwatch England points out that the difficulty of getting appointments is their most common complaint from patients adding that “it’s often unpaid carers, disabled people, people on lower incomes and those whose first language isn’t English that face the biggest challenges”.

At present less than a tenth of the NHS budget is spent on GP services. The BMA’s GP leader Dr Katie Bramall-Stainer said that for years “GP practices have been expected to keep doing more for less. General practice is collapsing”.

Now that we have a Labour Government the Tory Daily Express has turned attention to the inadequate state of GP premises and digital infrastructure. While it has likely taken up the cause simply as another stick to beat the incumbent government while turning a blind eye to the previous decade and half, it makes some valid points about the dire state of health service IT equipment. In particular it notes that outdated IT equipment makes it impossible for GPs to handle large volumes of data or use new equipment. This also makes speedy transfer of patient data from one GP practice to another or to hospitals difficult and often causes delays in treatment.

The RCGP also says the future is bleak and that the NHS England Long Term Workforce Plan to increase the number of GPs by four per cent by 2037 is inadequate, particularly when compared with a planned 49 per cent increase in hospital consultants. That figure alone suggests that plans for an increased focus on prevention have not been thought through.

The RCGP also reports that 40 per cent of GPs do not plan to remain in post by 2029. Many say this is due to stress and burnout. A few cynics have suggested that figure might be instead due to very comfortable pensions.

It also makes the valid point that if nothing is done, a further downward spiral is inevitable because “if more is not done to retain our current GP workforce, our already chronically understaffed general practice service will be woefully unprepared for the future. We’re in a vicious BER ctober ction cycle, with workload pressures rising to unsustainable levels, driving GPs out of the profession, and further putting the pressure on remaining staff.”

In Scotland the picture is much the same. Figures for the GP–patient ratio are harder to come by as practice size numbers are all that could be found. The ratio seems to be slightly better on paper, but the figures are ‘improved’ because of the larger number of small practices covering huge thinly-populated rural areas which presents different problems. However 17 practices now have more than 4,000 patients per GP. One has over 18,000 patients for just two GP partners, but it employs many locums.

One increasing solution is to go private. In 2019 there were only three private GP surgeries registered, there are now 11. In contrast the number of Scottish GP practices has fallen by almost 100 over the last decade to 897 with GP numbers falling from 4,514 in 2022 to 4,474 in 2023. Curiously more people are registered with GPs than live in Scotland. In 2023 eleven practices closed with doctors giving up in despair.

Some GPs say they are seeing 75 appointments per day, three times BMA’s guidelines. Some complain of 13-hour days. As former Labour leader Neil Kinnock once said: “I warn you not to be young, I warn you not to fall ill, and I warn you not to grow old.”