The latest GP story to scare us witless says that a “record number of GP practices closed last year, forcing thousands of patients to find a new surgery”. Pulse, the GP website, highlighted NHS England data that shows nearly 100 practices closed in 2016 – a 114% increase on 2014 – and that more than a quarter of a million people have had to change practice. Cue claims that GPs aren’t coping with increased demand, the NHS needs more cash and staff – and that the whole system is teetering on the brink of collapse.
But what’s the true picture? Are you likely to find yourself without a GP any time soon? Is the service contracting? And is the closure of a GP practice always a bad thing?
People get understandably upset when a much loved, familiar, local service shuts down. It doesn’t matter if it’s a GP surgery, library, community centre or takeaway. I’ve been registered at the same GP practice for 30 years; I never go, but I was quite discombobulated when I got a letter saying that one of the long-serving doctors was retiring. If I had memory impairment and long-term health problems, I’d be upset and anxious if the whole practice closed down and I had to move somewhere unfamiliar.
But let’s keep this story in perspective; there are 7,674 GP practices in England, so the closure of 92 practices means that 98.8% remain open. Primary healthcare services are not necessarily contracting; in 2014 there were 5,729 more GPs and 1,688 more practice nurses employed by GPs than 10 years earlier. Admittedly, a lot of those GPs and nurses work part time, and there’s also more work done in primary care now. So no one’s saying that there’s not a case for more money, training and efficiencies. It’s just that it’s not fair to paint an apocalyptic vision of sick people roaming the streets of England, looking in vain for a doctor to treat them.
Every person with an NHS number has the right to be registered with a GP and get primary care services, and access to hospital-based services if needed. If you assault your GP and are removed from the practice, the local clinical commissioning group (CCG) will refer you to a specialist GP who takes on the role of caring for the violent, abusive or just unmanageable. If you kill someone and go to prison, you have access to a doctor. There is literally nothing you can do in the UK that means you forfeit the right to see a GP. If all your local GP practices are full, the CCG has an obligation to find you one. Asylum seekers and refugees are also entitled to NHS care while waiting for their application to be processed and are encouraged to register with a local GP surgery.
The overwhelming majority of us who live in the UK will be registered with a GP from the day we’re born to the day we die. And in an era where Obamacare is under attack in the US, it’s worth celebrating what we’ve got in this country. Sure, the system’s not perfect, but there’s no evidence that any one system works better across all parameters; and no one can argue with the fact that our system is equitable.
There is a problem with the huge variation in quality between different GP practices. But inspections by the Care Quality Commission and the publication of its findings are helping to enforce high standards across the board. The CQC can demand an action plan when practices are found to be inadequate and shut down surgeries on the spot if they’re found to be unsafe. Every British GP has to undergo an annual appraisal, providing evidence that they meet professional standards. Any GP that fails to play ball can be denied the right to continue working. This is a completely different landscape to when I started working as a GP nearly 30 years ago. We are more inspected, regulated and scrutinised than ever – and quite right too.
But some GPs can’t hack it. There’s more work, more scrutiny and higher expectations now. Practices have to adapt, and many single-handed GPs find that hard. The climate nowadays favours larger group practices; there are economies of scale, a mix of skills among a range of GPs, less risk of professional isolation, and more chance of resisting the creeping penetration by large global healthcare organisations. Virgin Care already runs more then 400 NHS and social care services. Single-handed practices can’t fight the Goliaths who are sniffing round primary care.
So some GPs are taking early retirement, and fewer young medics are opting for general practice. And 1.2% of GP practices closed last year. Some of those practices will be a loss, some won’t. Many patients will be upset that they’ve had to move but no one will be left without a GP. And that’s the real story.
Let’s put our NHS worries in perspective – and celebrate what we have | Ann Robinson
