General Practice in danger of disintegrating!

Marching in Tower Hamlets against the closure of GP surgeries
Marching in Tower Hamlets against the closure of GP surgeries

‘GENERAL PRACTICE – and the NHS as we know it – is in danger of disintegrating unless the Chancellor urgently increases investment in the family doctor service to meet the tsunami of increasing patient demand,’ Dr Maureen Baker, Chair of the Royal College of GPs (RCGP), said on Monday.

Dr Baker stressed her concerns as a new poll, commissioned by the RCGP, showed that nearly all GPs (98%) disagree that general practice has sufficient resources to deliver safe patient care seven days a week. According to the study, conducted by ComRes, 91% of family doctors think general practice does not even have enough resources to deliver safe patient care within the existing service.

Meanwhile, according to further polling, also commissioned for the RCGP, two thirds (66%) of patients say that ministers should focus on improving existing services, rather than delivering seven day access to general practice. The findings of the two polls highlight concern that general practice no longer has sufficient resources to deliver an effective service to patients.

The poll of family doctors shows that:

• Three in ten GPs (31%) say they think it is unlikely their current surgery will still be open in 10 years’ time

• Ninety-nine per cent of GPs say their workload has increased over the last five years

• Ninety-four per cent say that fatigue has increased over the last five years

• Ninety-seven per cent say that morale has decreased over the last five years

• Nine in ten GPs (88%) say they worry about missing something serious with a patient because of their workload, and

• Three in ten GPs (29%) agree they have had to seek support, guidance or advice for work-related stress over the last two years.

Meanwhile, according to the concurrent poll of patients:

• Three in ten (31%) patients report that, when they last tried to book an appointment with their GP, they were not able to book an appointment within a week

• Two thirds (66%) of patients say that GPs conducting between 40-60 consultations a day is a threat to the standard of care they can provide for their patients

• Around half (48%) of British patients think that waiting times to get an appointment will get longer

• More than four in ten (43%) patients say that they are concerned about the impact of current waiting times for an appointment to see their GP on their health, and

• More than half of patients (56%) think that some health service funding should be moved into general practice from other areas.

The College is calling for an urgent cash injection into general practice when Chancellor George Osborne delivers his Spending Review on Wednesday – with an additional £750m investment per year on an annual basis from April 2016, rising to an additional annual spend on general practice of £3.8bn per year by 2020.

This would mean that general practice would receive around 11% of the NHS budget, up from 8.4% now – despite the fact that general practice conducts 90% of the patient contacts in the NHS. Among other things, the increase in investment would pay for the implementation of the recommendations of the Primary Care Workforce Commission report, led by Professor Martin Roland, published earlier this year by Health Education England.

The College calculates that implementing the Commission’s recommendations in England would cost an additional £1.66bn in general practice annually by 2019/20, together with a further £709m for community nursing services. This would deliver an additional 5,000 GPs, 5,000 medical assistants, 4,300 practice-based pharmacists, 1,000 physician associates, 2,275 practice nurses and 9,469 community nurses.

With dramatic demographic changes taking place over recent years, with the population ageing and getting larger in size, GPs are conducting at least 370m patient consultations every year – 60m more than five years ago. The RCGP says that by investing in general practice, more people can be cared for at lower cost in the community, saving the NHS money – and reducing the need for expensive hospital treatment.

Independent research produced for the RCGP by Deloitte shows that increased spending on general practice across the UK could lead to short term savings of up to £447m annually, comprising:

• £133.9m per year, through diverting up to 1.7 million patients away from A&E

• £143.3m per year, through reducing the number of unnecessary ambulance call-outs

• £170.1m per year, through reducing the length of hospital stays for patients aged over 65, by providing greater primary care support at home.

When medium term savings from better management of people with long term conditions is factored in, this could rise by a further £333m across the UK, to reach £780m by the end of 2019/20.

Dr Baker said: ‘The results of our polls show that general practice is on a knife-edge, with GPs feeling that there is insufficient resourcing to deliver a five day service, let alone a seven day service, and two thirds of patients feeling that the high number of consultations being carried out by GPs is a threat to the standard of care they can provide to their patients.

‘With the population ageing and growing in size, resulting in an increasing prevalence of serious long-term conditions, it is of little surprise that GPs’ workload has soared, while morale has plummeted.

‘With this week’s Spending Review, the Government has the opportunity to stop the rot, and start investing in a renewed general practice – based on the recommendations of the Roland Commission – which would allow family doctors, and other members of their teams, to cope with the tsunami of increasing patient need in the community. If the Government starts to invest in general practice, GPs will be able to save the NHS money, by reducing the need for expensive hospital treatment.’

She added: ‘The Spending Review marks a make or break moment for both general practice and the NHS. Invest in a renewed general practice, which is the cornerstone of the health service, and you can support the NHS into the future. Fail to invest in general practice in the Spending Review, and general practice and the whole of the NHS will collapse before the end of the current parliament. It’s as simple as that.’