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Unrelenting demand

Hard-wired GP

Luke Koupparis

Wednesday, 13 April 2016

stressed doctor_shutterstock_99254666.jpgDemand in general practice is rising and patients are increasingly waiting longer to get appointments. It is now not unusual to see a queue of people forming outside a surgery before the doors have opened in the morning in a bid to get the few scarce appointments that are released that day.

Primary care sees an estimated 370 million patient consultations each year which is 60 million more than 5 years ago, equivalent to over 90% of all NHS contacts. Some GPs are routinely seeing 40-60 patients each day. All of this is delivered for 8.39% of the total NHS budget.

As a GP, I have felt this pressure first hand and it seems that we are powerless to be able to stem this demand without working even longer hours. A new Royal College campaign has now been released that suggests that GPs should work in a similar way to airline pilots, taking regular breaks to ensure patient safety and protect themselves. It suggests that most patients would not choose to be the 50th encounter at the end of the day. However, the unrelenting request for appointment capacity and doctor time, makes this ideal suggested by the RCGP, a long way from the reality on the ground.

So how on earth do we find ourselves in this situation with demand outstripping supply and the RCGP forced to provide parallels with the aviation industry to prevent mass burnout in the profession? Well, there are multiple causes, that when combined, result in more and more consultations being shifted into primary care.

In addition, we have a workforce crisis with swathes of GPs retiring from partnership. First, it was thought to be only the doctors nearing retirement, whereas now it has been seen that many doctors in their 30s and 40s are also leaving. Data shows we are faced with a lack of new trainee blood coming into practice with over 600 posts unfilled last year. The Department of Health pledged that they will find an additional 5,000 GP by 2020 to plug this gap, but has now had to water this down, suggesting that this will include doctors in training, which gives them an extra 3 years to hit the target. However, as the bitter dispute with the junior doctors rages on, with many voting with their feet and leaving the UK, it seems ever likely that fewer trainees will filter through in the coming years.

The think tank, Reform, has published a report this month that looks at the future of primary care and suggests that we need a seven-day service, dismissing suggestions from the BMA and RCGP that there is little demand for this. Reform suggests a solution to the workforce crisis would be by delivering appointments by other healthcare professionals. However, they fail to outline areas such as where the clinical responsibility lies with this model, more than likely to be the GP overseeing an extended team.

The report criticises the lack of use of technology in primary care, citing the statistic that only 7% of appointments are booked online. They fail to understand the crux of the issue here, as most practices already have online appointment booking. The issue is that when you have increasingly scarce appointments, then any form of booking will be reduced and patients are forced to attend the surgery to make their case for an appointment face to face.

It also goes on to suggest that GPs should use better use of video consultations via smart phones or other devices, and that 20% of patients would not seek a GP appointment if they had better access. However, using video consultations may not require a patient to attend in person, but there is no evidence that it will save any time over a face to face or telephone appointment.  

So, despite the statements from the Secretary of Health that he values the respected and envied position of primary care in the UK and wishes to retain this jewel in the crown of our NHS, his tactics seem to be intent on destroying the current structure and rebuilding it in a new form. GP surgeries are being battered into submission with unrelenting demand and doctors leaving, burnt-out or to overseas countries, where their skills are valued and respected. He ignores statistics from organisations, like the BMA and RCGP, preferring to refer to reports that serve his aim of recreating a primary care service in a cheaper more fragmented way.

As humans, we regularly fail to see the value in things we already have in our lives and take these for granted. The Government clearly doesn’t see the value in general practice and is looking for something different and better.

However, we may be faced with this new primary care landscape in the not too distant future and then we will all realise the value of what has been lost.

Author's Image

Luke Koupparis

Luke is a general practitioner in the Bristol area with interests in men's health, child health, minor surgery, online education and medical information technology. He is the IT lead for Bristol clinical commissioning group, LMC representative and chair of the locality provider group. He also works as the medical editor to OnMedica helping to deliver high quality, peer reviewed information to the wider medical community. In his spare time he is a keen road cyclist and likes to ski with his children.
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