The government has pledged 5,000 new GPs in post by 2020 – but numbers are actually set to decline.
Health Secretary Jeremy Hunt has pledged a “new deal” for GPs aimed at fulfilling a Tory election manifesto commitment to boost the number of doctors in post by 5,000 over five years. The manifesto also promised 7-day access to GP services. Patient groups and doctors are not impressed. In reality GP numbers are set to decline.
Local schemes will offer enhanced salaries including “golden hellos” of £20,000 as an inducement to the newly qualified to opt for general practice. They will only have to commit to staying in post for two years and can refuse weekend and evening work.
Hunt bemoans extreme variation across the country with one doctor to 750 patients in some areas, one per 3,125 in others. He says he is looking to attract more doctors into general practice to stop hospitals, in particular accident and emergency units, being overwhelmed by patients.
There will be a million more people over 70 by the end of the decade and 100,000 more people to be cared for at home. Three million patients will have three or more long-term conditions by 2018. Hunt has known about these issues from the day he was appointed – and has taken no strategic action to address them. Practice nurses form part of his solution, yet 30,000 training places were cut in the last Parliament.
Patient groups have criticised these proposals pointing out that ad-hoc payments are not the answer. We already have the highest-paid primary care doctors in the industrialised world. Patient welfare campaigning group Patient Concern described his plans as outrageous and inadequate. They point to the stifling bureaucracy imposed by an internal market that prevents GPs from focusing on patient care without unnecessary distraction.
Last September the Health Education England Task Force declared a crisis in general practice. Their Centre for Workforce Intelligence stated that the current GP workforce was incapable of meeting current demand. Recruitment onto training schemes has been falling year on year since 2010.
The British Medical Association conducted its biggest survey ever, analysing 15,000 returns from doctors working in primary care. This revealed that one in three GPs intends to retire within the next five years and one in five trainees declared they want to seek employment abroad.
‘The internal market prevents GPs from focusing on patient care.’
Spending on general practice is now just under 8 per cent of total NHS revenue against 11 per cent in 2010 when the coalition took office. In 2013-14 the allocation made was £287 million lower than in the previous financial year. The proportion of NHS doctors working in primary care has fallen from 34 to 25 per cent during the same period. Between 2006 and 2013 GP numbers grew by only 4 per cent compared to nearly seven times that rate for doctors working in hospital and community services.
Health Education England has suggested that half of all medical students should specialise in general practice. In 2015 it will be one fifth, and one in ten training slots within GP practices remain to be taken up. Unfilled vacancies for qualified doctors are endemic. The percentage of unfilled posts quadrupled over three years, up to 7.9 per cent in 2013. In 2014, 104 practices applied to NHS England to stop accepting new patients because of workload pressures – double the number of two years previously.
GP services have consolidated in an attempt to meet rising demand through economies of scale. Between 2006 and 2013 numbers working as single-handed doctors has halved. Practices with more than ten partners have increased by 76 per cent. But the Royal College of General Practitioners estimates that 543 practices in England are at risk of closure because GPs working in them are aged 60 and over.
The College estimates that England needs 40,100 family doctors to meet the needs of an ageing population. There are currently 32,075 in post. Another 1,000 doctors a year will retire from the profession in coming years.
Another pressure (often not mentioned) is the growth in population through inward migration.
So we need 13,000 new doctors by 2020. And with early retirements and departures abroad, the need for retraining places is high. That makes the Tory pledge of “an additional 5,000 extra GPs” look ignorant as well as ungrammatical.
● Related article: What's needed?