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General practice still on brink of collapse, warn GP leaders

Government must ‘abandon the callous disregard of patients through austerity and cuts’

Louise Prime

Thursday, 29 June 2017

General practice remains on the brink of collapse, the BMA’s GP committee chair has warned, with “demand totally outstripping our impoverished capacity” as it faces 50 million more patients a year than it did five years ago. He accused the government of turning “a cruel blind eye to the needs of patients” over the past year, and said the general election result of a minority government was a “clear mandate to abandon the callous disregard of patients through austerity and cuts”.

At the BMA’s Annual Representative Meeting in Bournemouth, Dr Chaand Nagpaul told delegates that the individual GP practice unit “is frighteningly vulnerable”, with one in 10 of those surveyed saying they’re not financially sustainable. And he said it was unsurprising that a record number of practices closed last year, given that one in three practices are unable to fill GP vacancies.

He argued that although in England the government last year introduced its GP Forward View investment programme, “this is operating within a wholly inadequate NHS pot” and is insufficient to sustain general practice – which is why, he said, the GPC is demanding fit-for-purpose resources for GPs to work within safe workload limits. He said the government has ignored pleas from NHS England chief executive Simon Stevens, the Parliamentary health select committee “and all authoritative opinion” that the NHS is in desperate need of more resources. He pointed out: “Now policy makers and even the GP Forward View explicitly states we’ve been starved of resources, with too few GPs and excessive workload.”

In his last speech as GPC chair after four years in the post, Dr Nagpaul called for action to liberate the one in four GP appointments that are avoidable – for patients who could have self-cared or seen another professional, or those appointments taken up for inappropriate or bureaucratic purposes – to increase GP capacity by 25%. He claimed the effect would be “far greater than the political mirage of 5,000 more GPs”.

He then protested against the potential damage from privatisation of NHS services, highlighted in the past year by Capita’s “complete mishandling of the delivery of primary care support services in England”, which he said showed that “You simply can’t run the health service using cost-cutting commercial tactics.” He said that even though this had adversely affected quality and safety – with GPs trying to care for patients without medical records – it had “shamefully escaped the regulatory vilification that practices would receive from CQC inspections for a fraction of such shortcomings”.

Dr Nagpaul called for GPs to support each other as a united profession, especially as the workforce diversifies – about 40% of GPs are not covered by the national contract, with increasing numbers wanting to work as freelance locums, salaried, and portfolio roles.

Otherwise, he argued: “If the partnership model collapses it will sink the entire profession in the process, with the risk that all GPs will in the future be at the mercy of working for large commercial providers, who are likely to have values and an ethos at odds to everything we stand for.”

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