by GK Strategy 13th February, 2017

Is the real NHS humanitarian crisis in GP shortages?

Last week marked the two year anniversary of the Royal College of General Practitioners (RCGP) publishing a league table which revealed the extent of GP shortages across England. The data showed that a 50% increase in the number of GPs was needed in certain areas before 2020 – largely due to the ever growing population. The RCGP concluded that 8,000 was the magic number of new full-time GPs that were needed to deal with the workforce crisis, but what progress has been made since then?

Firstly, when we look at patients’ perception of their GPs, the data does not look overly promising. Pulse’s 2016 Patient Survey shows that the average waiting time for an appointment last year was just under 13 days, which is a sizeable increase from 10 days in 2015. Within the same survey, around 41% of GPs said that the wait was longer than two weeks, with 15% saying it was longer than three weeks. Perceptions are equally negative when looking ahead; respondents said that they expect the average waiting time in 2017 to rise to around 17 days.

Also, when we look more broadly at the staffing challenge, the former RCGP President, Dr Maureen Baker, has suggested that vacancy rates have been running at more than 10% and when we drill down into regional figures the outlook continues to appear bleak. For example, according to a NHS report last year, Cumbria is currently experiencing a significant workforce recruitment and retention “problem” that “presents a major barrier to improved quality, performance and sustainability”. Across both GP practices and hospitals, Cumbria now relies on locums to provide large swathes of its services. Becoming a partner of a GP practice does not appear to hold the same stature it did a couple of decades ago, when there were too many newly qualified GPs for the number of positions. This raises questions as to where it leaves the continuity of care from the fabled ‘family doctor’. This problem will unquestionably be exacerbated with the likely mass retirement of older GPs over the next few years. This, along with the ageing population, pressure on NHS budget and shortage of GP’s, is creating a perfect storm in primary care.

The Government argues that their recent announcement increasing the number of medical student places at UK universities is the pill that will alleviate the shortage of GPs. Get more into the workplace is their answer, but how will this solve imminent challenges? Putting aside the fact that this decision was prompted by the abject failure of the Government to foresee a health workforce crisis in 2012, it is still a policy that will take years for any impact to be felt. Before the multi-year GP training can even start, the Government is expected to open a public consultation in the next month outlining just the mechanism that they will use to allocate the places to UK universities, which highlights just how long this process could take. No additional training places will be introduced until 2018 and with a Government committed to reducing immigration to the tens of thousands, it is unlikely that the workforce gap will be filled by highly qualified non-British doctors alone.

However, what is more interesting about the current GP shortage is the lack of public outcry on the issue. Politicians, campaigners and media figures have been quick to attack the Government for failing to provide an additional resource for hospitals and a social care system gasping for further funding. Yet many loud voices within the sector have neglected to mention the impending crisis in GP care. Theresa May was right that GPs can relieve pressure on acute care providers, but in the current climate of serious under-resourcing, this is an impossible ask. So why did so few campaigners continue the fight and press home the issue of highlighting the plight of GP shortages?

The answer appears fairly benign. With the horror stories emerging of elderly people dying on beds wedged into hospital corridors due to overcrowded and understaffed hospitals, what room is there for arguments about waiting longer for an appointment with your GP? With humanitarian crises being declared by a charity synonymous with tackling famines, wars and devastating floods, what room is there for arguments about the overuse of locums in Cumbria and other parts of rural England? The reality is that the political and media bandwidth has a maximum capacity and it remains focused elsewhere. Two years on from the damning RCGP league table, the challenges facing GP surgeries remain acute and prolonged.

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