In the NHS we are critically short of GPs, yet there are obstacles to solving this problem wherever you look, as well as plenty of reasons for doctors to look elsewhere for work. A perfect storm of increased workload, decreasing numbers of new GPs and chronic under investment has led to a crisis within the profession that needs addressing immediately.
Recent figures from Health Education England suggest that almost a third of GP training places are still vacant for next year. This is hardly surprising given the constant bad press GPs receive which means that morale within the profession is currently at an all-time low.
The reduction of social care budgets combined with an ageing population is leading to increased workloads. Patients are seeing GPs more often and consultations are taking longer than they were ten years ago. Consequently the system has become absolutely saturated.
Many new junior doctors are choosing to go into hospital work or even move abroad. Currently, Australia and Canada are both popular destinations, where pay is better and there is less bureaucracy.
There are increasing vacancies in general practice that remain unfilled. A retirement time-bomb is about to happen, thanks in part to changes in the NHS pension and increasing burn-out. Those GPs retiring generally work full-time and are male, with those joining the profession predominantly female, but also male, and looking for part-time careers.
The overcrowded accident and emergency departments are really a symptom of the problem in general practice. Patients are finding it harder to see a GP, and the sponge that is general practice is now saturated.
UK medical schools are renowned worldwide and receive a large number of applications each year (ten for every place). Despite the widespread expansion of medical schools in recent years, we still find ourselves importing doctors from abroad to help with shortages.
Prior to the election, the Conservatives pledged that 5,000 new GPs would be in post by 2020 but all indications suggest we will fall well short of this. In general practice, available training posts are increasing while applications decrease.
The shortage of GPs is challenging the already stretched workforce of doctors who are willing to work for out-of-hours providers. A large part of this is because of the issues already discussed – such as increased workloads but also rising indemnity costs - which make it no longer viable for GPs to work these extra hours. With the proposed introduction of a seven day GP service, willingness to work for out-of-hours services is only going to decrease.
More integration of government funded projects/vanguards is needed to get the most of the workforce. Currently these projects work separately from local services and efforts are often duplicated. Special government projects, which are often only short-term, end up competing with out-of-hours for the limited available workforce, but can often offer a better rate of pay. This leads to the destabilisation of the out-of-hours services with longer contracts.
There isn't an easy fix for the problem engulfing the GP profession at the moment. The issue has been building for years and is likely to get worse before it gets better, as older GPs head towards retirement, without enough replacements coming through at the other end.
There are, however, changes that can be made to improve the situation in the long-term and stop us getting to a point of no return. GP practices need greater management and guidance from above to help them cope with the strains being put on them by the shortage of GPs. Government incentives, such as golden handshakes for new GPs in areas with particular shortages, have had limited success but more needs to be done. Other healthcare professionals need to be utilised better; pharmacists and nurses should be used more for minor ailments to free up doctors for more complex cases. Most of all, funding into general practice, both in hours and out of hours, needs to be increased.
Dr Michael Harrison is Organisational Medical Director at the Vocare Group, which provides urgent healthcare services to ten million patients countrywide, through urgent care centres, GP out-of-hours services, integrated urgent care centres and the NHS 111 service.
Last year Vocare removed a major obstacle to more GPs working out-of-hours shifts by signing an innovative new agreement which means they will no longer have to pay a premium on their own indemnity insurance. The company has also been very active in increasing the flexibility of its workforce by introducing the use of GP triage.