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General practice has ‘serious structural faults’

GP leader warns of unmanageable pressures

Jo Carlowe

Tuesday, 26 June 2018

General practice is at risk due to unmanageable workload pressures.

This was the message delivered by Dr Richard Vautrey, the British Medical Association’s GP Committee UK chair, at the organisation’s annual conference in Brighton.

Delivering his speech at the Brighton Centre, Dr Vautrey described general practice as the foundation of the health service.

“For 70 years, general practice has been the foundation on which the NHS has been built…It’s been on this foundation of general practice, and the primary care we provide, that other NHS services have depended. We’ve managed demand, enabled efficient working elsewhere in the system, directed patients to the right specialist service, been innovative in care pathway design, and above all managed clinical risk on behalf of the NHS as a whole.

“But when nearly 40% of GPs intend to quit direct patient care in the next five years, and over 90% of GPs are reporting considerable or high workload pressures, we know that the foundation of general practice has serious structural faults. When instead of gaining an additional 5,000 GPs, we’ve lost over a 1,000, we know that the foundation of general practice is cracking. When over a 1,000 GPs have referred themselves to the new GP Health Service in England because of stress and mental health problems, or when hundreds of practices have closed and over a million patients have been forced to look for a new GP service, we know that the foundation of general practice is breaking down.”

Dr Vautrey said GP services had been undervalued and taken for granted.

“GPs’ work ethic and dedication to their patients has been exploited through a decade of underfunding and soaring workload pressure, with the assumption that the GP practice will always be there to pick up the workload that others say they cannot or will not do.

“The NHS fails to commission a specialist service, well don’t worry, the GP can do it; local authorities cut smoking cessation or weight management services, but don’t worry, just make an appointment with your GP and they’ll prescribe what you need; a new specialist care home or private hospital opens up in an area without any warning or planning, but don’t worry, the GP will pop around regularly to visit everyone; and then some bright spark comes up with a well-meaning idea that just requires the patient to get a letter from their doctor, but don’t worry because that’s what GPs are there to do, isn’t it?

“Well let me make it clear, it is now time to worry. The foundation of general practice on which the NHS is built is seriously at risk of collapsing and if the NHS wants to survive in to old age we need urgent action now. If we cherish our NHS it’s time to save general practice.”

Dr Vautrey called for “real investment” that provides an additional £3.4bn recurrently each year.

“We need to seriously step up our workforce plans to ensure every practice can recruit a GP when they need to and that existing GPs are properly supported to encourage them to stay in the service. We need to ensure every practice has the support of a pharmacist working in their team, to not only reduce GP workload, but to improve the safety of patient care and reduce medicine related adverse incidents.

“We need to invest properly in premises, to reduce the risks for those potentially left last-person-standing and prevent bodies like NHS Property Services from pushing practices to the point of closure by their unacceptable and unjustified cost hikes.”

Dr Vautrey called for a step change in IT support, a need to protect GPs’ independent contractor model of working and the partnership model that gives GPs a voice in decision-making, and for equity with hospital colleagues when it comes to indemnity.

Commenting to OnMedica, a Department for Health and Social Care spokesperson said: “GPs are a crucial part of the NHS - that’s why we are increasing investment by £2.4 billion a year by 2020 and more than 3,000 GPs are expected to be recruited into training this year.

“Just last week the prime minister announced increased funding for the NHS by £20.5bn over the next five years – to secure the future of the health service as it approaches its 70th birthday and ensure we can deal with the pressures of a growing ageing population.”

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