Anyone who has visited their GP recently will be aware of the pressures: the struggle to get an appointment, the difficulty of seeing the same GP more than once, the rush to get you out of the door for the next patient.
The crisis in general practice is unprecedented. The health secretary, Jeremy Hunt, fails to understand the seriousness of the situation facing general practice in England.
There are now 8,000 GP practices in England – one in 20 has disappeared since 2010. The rate of loss of local surgeries has increased. There has been a fivefold rise in the number of GP surgeries approaching senior NHS managers for advice about shutting their doors or merging with nearby practices. Furthermore, a freedom of information request by Pulse magazine revealed 58 practices closed in 2016, with a further 34 shutting because of mergers.
The failure to acknowledge the crisis facing GP services – an under-resourced, over-stretched shell of their former self, struggling to keep pace with patient demand despite the efforts of their staff – could finish off the general practice, “the jewel in the crown of the NHS”, in next few years for good. Hunt never tires of saying GPs are central to his vision for the NHS. But the gap between policy rhetoric and reality has never been starker.
The NHS has the most stressed GPs by western standards, as a result of relentless workloads, endless bureaucracy and the shortest time spent with patients. We have been squeezing the lemon for all sorts of healthcare needs for years. But it is getting to the stage where there is nothing left to squeeze.
The government is asking GP practices to provide more services, including many involving the transfer of hospital care into the community, without the resources required to successfully deliver them. And now, NHS England wants 12 hours a day, seven days a week opening in general practice.
There are not enough GPs to cover current working hours. The colleges want 10,000 more GPs to service the present demand. The promise of 5,000 new GPs not only ignores the fact that the pressures of the profession are putting medical graduates off joining, but also that it takes a good eight to 10 years to train. Practically, it’s not possible to pull so many GPs out of the hat.
Despite all this, Hunt talks of more care in primary care, more access, initiatives and ideas – ignoring the workforce crisis, a funding disaster and the committed GPs facing burnout. General practice’s share of the NHS budget has fallen progressively in the past decade, from a high of 11% in 2006 to less than 8.5% now. Many practices will see further reductions over the next three years, forcing further closures. A combined financial and staffing crisis could cause chaos in primary care for years and ultimately kill off general practice for good.
The root cause of the crisis is this unprecedented combination of rising patient demand and declining resources. Practice incomes have been frozen for several years and this has led to real net incomes dropping by more than 20% since the introduction of the GP contract in 2004. Practices are being brought to their knees by this unprecedented fall in money for primary care and rising demand for GP services. Primary care is imploding faster than people realise and patients are already bearing the brunt of the problem.
General practice is the bedrock of many NHS services and the gatekeeper to the rest. We can either confront the realities facing practices and make plans now to meet growing challenges – or we can bury our heads in the sand and watch this key part of the health service slide into terminal decline.If general practice fails, the whole NHS fails.
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If general practice fails, the whole NHS fails | Kailash Chand
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