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Nearly one in three GPs set to leave profession within five years, survey shows

Bolster efforts to retain existing workforce, urges Royal College of GPs

Caroline White

Monday, 03 December 2018

Nearly one in three GPs are set to leave the profession within the next five years, citing stress and retirement as the principal reasons, reveal the responses to a representative survey carried out by the Royal College of General Practitioners (RCGP).

Efforts to retain the existing workforce, including reducing GPs’ workload, need to be strengthened, says the College.

ComRes interviewed 1094 English GPs online and by phone between 16 August and 26 September 2018. Data were weighted to be demographically representative of all English GPs.

The responses show that nearly one in three (31%) said they are unlikely to be working in general practice in five years, citing stress and retirement as the main reasons.

One in 20 (5%) of GPs said their practice was likely to close within the year: these are practices that are not merging with others.

And nearly four out of 10 respondents (37%) said that in the practice where they work, GP vacancies have been open for more than three months.

Efforts to retain the workforce need to replicate the "excellent" work that has gone into increasing recruitment to general practice, which has seen more GPs in training than ever before, the College says.

It has also analysed the latest provisional workforce data from NHS Digital for September 2018, published last month, which showed an increase of 41 GPs from September 2017.

However, looking back to September 2015 – the last set of workforce data before NHS England's GP Forward View was announced, with a pledge of 5,000 more GPs by 2020 – the total number has dropped by 460.

Taking the data at Clinical Commissioning Group (CCG) level, it has identified where in the country the biggest and smallest increases in GP numbers have occurred since 2015.

Areas with the biggest increases up to 2018 include Liverpool CCG (87); Northern, Eastern and Western Devon CCG (67); Kernow CCG (54); Lambeth CCG (45); and Gloucestershire CCG (41).

Areas with biggest falls in GP numbers over the same period include: Horsham and Mid Sussex CCG (-52); Walsall CCG (-33); Portsmouth CCG (-29); Hull CCG (-22); and Thanet CCG (-19).

The College says that a primary factor in GPs leaving the workforce prematurely is excessive workload, which has risen substantially in recent years, both in volume and complexity. Yet the share of the NHS England budget general practice receives is less than it was a decade ago, and GP numbers are lower than they were three years ago.

Last month the College renewed its long-standing calls for general practice to receive 11% of the overall NHS budget as part of the forthcoming 10-year plan for the NHS.

The recent announcement that £3.5bn of the promised £20.5bn NHS uplift would be allocated for primary and community care shows a commitment to supporting healthcare services closer to home for patients.

But general practice currently receives 9.5% of the NHS England budget, and the College has called for assurances that general practice, specifically, will be a key recipient of this new funding.

It says that 11% of the budget for general practice would enable the provision of larger practice teams, which would allow GPs to spend more than the standard 10-minute consultation with patients who need it.

And it would enable a wider range of healthcare professionals to be deployed to provide a wider range of clinical services in GP surgeries.

The money could be spent on IT systems, allowing more surgeries to use video consultations as standard, and to enable joined-up care across the NHS.

It would ensure that modernised, fit-for-purpose surgeries were the "hub" of the community, and provide for a bigger workforce, where more healthcare professionals opt for general practice as a career and are supported by better-funded training placements in the community.

Professor Helen Stokes-Lampard, RCGP chair, commented: "All GPs are overworked, many are stressed, and some are making themselves seriously ill working hours that are simply unsafe, for both themselves and their patients - it is making them want to leave the profession. It is forcing some GPs to hand back their keys and close their surgeries for good.

"This is having a serious impact on many of our patients, who are waiting longer and longer to secure a GP appointment. But it also means we don't have the time we need with patients – particularly the growing number living with multiple, complex conditions – so the standard 10-minute appointment is simply unfit for purpose.”

She continued: "About a third of the GPs we surveyed said they were unlikely to be working in general practice in five years' time. This is gravely concerning. We are talking about highly-trained, highly-skilled doctors that the NHS is at risk of losing – some will retire, which is to be expected, but many are planning to leave earlier than they otherwise would have done because of stress and the intense pressures they face on a day to day basis, whilst simply trying to do their best for their patients.

"These GPs are the ones we need to be focussing our energy on – to make their working situation safer and more sustainable,” she urged.

She added that NHS England and Health Education England had done “excellent work”, supported by the RCGP and others, to encourage more doctors to specialise in general practice and that there were now more GPs in training than ever before.

But she pointed out: “GP specialty-training takes three years, and if as many GPs are leaving the profession as entering it, we are fighting an uphill battle, when realistically we need thousands more.

"We need to see this level of effort replicated in initiatives to retain GPs already in the profession, to reduce our escalating and often unnecessary workload, and to support GPs and our teams' own health and wellbeing.”

British Medical Association (BMA) GP committee chair, Dr Richard Vautrey, said the survey findings were “alarming.”

He added: “While GPs strive to provide high quality care to all of their patients, statistics such as this speak volumes to the huge amount of pressure they are under; rising demand from a growing population with increasingly complex conditions means that workload is nearing insurmountable levels.

“Given the stress this causes and impact that it has on doctors’ wellbeing, it is unsurprising that many are questioning their own futures and the future of their practices.”

The BMA is calling on the government to drastically increase the share of the NHS budget, he said.

“For the last 70 years general practice has been the foundation on which the NHS is built, but without proper support, investment and a plan to tackle the current retention crisis, it is in serious risks of crumbling.”

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