Priorities for Health: General practitioners
November 2006
Introduction
General Practice has been the cornerstone of the NHS since its inception in 1948 and is the part of the NHS that patients know best and appreciate most. It is crucial in providing patients with continuity of high quality, personalised healthcare and in enabling appropriate patient access to wider NHS care. Politicians must give due consideration to general practice when debating and deciding on policies on the provision of healthcare, disease prevention and the NHS.
GPs play a vital role, not just in tackling illness but also preventing it. With smoking, alcohol consumption, diet and exercise being the most important controllable factors contributing to the development of major diseases, GPs can contribute to improving patients’ lifestyles by promoting healthy living and providing preventative care.
Investing in general practice can make a real difference to patient care. Plans to deliver more care outside of hospitals and closer to patients’ homes will only be effective if GPs are engaged and involved in developing and delivering services to patients. In order to do this, politicians must ensure that the workforce has the capacity to deliver on government promises.
Background
Scotland has first class doctors, but supply does not match demand. In August 2006, BMA Scotland conducted a survey of members to obtain their views on the priorities for health for the next Scottish Parliament. More than half of respondents agreed that there was a shortage of doctors in the medical workforce and a quarter (26%) reported medical vacancies in their GP practice or hospital department. Doctors reported that more than half (54%) of these vacancies have existed for six months or longer.
More than 90% of doctors in the survey said there was a need for detailed medical workforce planning in Scotland.
General Practice – the need for workforce planning
The most recent workforce figures for general practice (September 2005) show that there are 3783.2 whole time equivalent (wte) GPs in Scotland (the headcount figure is 4231). Over the past ten years the number of GPs in Scotland has increased on average by less than one per cent each year and although the number of salaried GPs has increased by 300 per cent since 1995, the number of GP performers (i.e. partners) has increased by only 0.4% [reference 1].
The demography of the medical workforce is changing. Almost one third (30%) of the GP workforce is aged over 50 and it is anticipated that in April 2007 there will be a retirement ‘bulge’ as many doctors nearing the end of their careers decide to leave general practice. In 1995, only 35% of the GP workforce was female, in 2005 this rose to 46%. Looking to the future, there are currently 307 GP Registrar training places (290 wte) in Scotland, with almost 60% of GP registrars being women.
At present, the number of GP registrar training places is capped at around 280 wte per annum. In the last five years however, only around 230 registrars have completed their training, probably due to the increase in the number of GPs in training who are taking their maternity leave during their GP registrar year.
This ‘feminisation’ of the GP workforce will lead to an increased demand for family friendly working patterns and, paired with a trend in society for more flexible working patterns, this will have an impact on workforce planning.
The Royal College of GPs (Scotland) conservatively estimates that by 2012, Scotland will be short of at least 750 GPs. This is because of a combination of the changes in the demography of the medical workforce, the capping of GP registrar training numbers and the shift in service delivery from hospitals into primary care.
Because of these changes in the GP workforce, it is now more important than ever for government to undertake detailed workforce planning and take action to increase the number of GPs in Scotland.
Provide funding for more GP training places in Scotland
At present, the number of GP Registrar training places in Scotland is significantly lower than the 300 to 340 GP training places that existed in the 1980s.
The reduction in training numbers to 280 was made during the early 1990s. At this time, general practice was a less popular option for medical graduates and recruitment was difficult. Recently, however, there has been an increase in the number of applicants for GP training places in Scotland. It would seem counterintuitive to turn away young doctors who are interested in training in general practice when there is a strong likelihood of a future GP workforce shortage and when the emphasis of Delivering for Health is to provide more services within the primary care setting [reference 2].
In our view, the implications of this situation are serious. If future workforce requirements are to be met, we believe that urgent consideration must be given to increasing the number and scope of funded GP training places in Scotland.
In addition there are challenging decisions to be made to facilitate the implementation of the medical training reforms (Modernising Medical Careers) in Scotland. The Royal College of GPs curriculum (which is still only a 3 year curriculum) calls for more of the training of future GPs to take place in a community setting. It is widely accepted that revised training along these lines will produce GPs who are better able to cope with the increasingly complex needs of their patients. By providing more appropriate training it is likely that more doctors will feel able to commit to a post in general practice, especially in the more challenging rural and inner city areas. This will inevitably improve recruitment to these areas.
Invest in improving GP premises throughout Scotland
In May 2006, the BMA published a UK-wide survey of GP premises which found that three quarters of GP practices who responded to the survey said that their premises are not suitable for anticipated future needs [reference 3]. BMA Scotland believes that this prevents general practice from reaching its potential and demonstrates that current funding levels for premises are insufficient.
Three quarters of GPs felt that their surgeries were not suitable for their expected future needs, and two thirds of the practices said that their clinical staff ‘hot desked’.
If practices could extend or improve their premises, family doctors would be able to provide extra patient services as well as taking on additional GPs, nurses and other health professionals, in line with the current NHS Strategy - Delivering for Health.
The lack of space is also hampering practices from training GPs. Only 46% of practices in the survey felt they had enough room to provide training for GP registrars.
More than a third of practices were unable to make the necessary adjustments for the Disability Discrimination Act. Furthermore some doctors believe that the cramped conditions raised issues of patient confidentiality.
A critical shortage of investment is to blame for the premises problems in general practice and this should be tackled without delay.
Implement measures to encourage GPs nearing retirement to remain in practice and extend family friendly policies.
The BMA believes that the introduction of flexible working arrangements and GP returner schemes for those temporarily opting out of the workforce for family or other reasons will ensure that these highly trained and skilled professionals are not lost to the NHS.
Meanwhile, schemes to retain GPs close to retirement by providing appropriate step down arrangements will provide some short-term solutions to workforce problems. Recent research has found that 70% of doctors aged over 55 surveyed in Scotland would be interested in a retirement-retention scheme, allowing doctors nearing retirement to work flexibly or at a different pace [reference 4].
NHS family-friendly policies should be strengthened within general practice to enhance recruitment, including better access to maternity, paternity and adoption payments to support practices whilst partners are on leave. This will ensure that practices are not discouraged from recruiting GPs who may wish to take extended family leave.
Recommendations
In order to increase the number of GPs in Scotland, the BMA calls on political parties to:
- Undertake detailed workforce planning and action to increase the number of GPs in Scotland.
- Provide funding for more GP training places in Scotland.
- Invest in improving GP premises throughout Scotland.
- Implement measures to encourage GPs nearing retirement to remain in practice and extend family friendly policies.
1. NHS Scottish Health Statistics GP Workforce available online [www.isdscotland.org] (accessed on 23 October 2006)
2. Scottish Executive Health Department Delivering for Health , Edinburgh, Scottish Executive 2006
3. BMA Health Economic Policy Research Unit Survey of GP Practice Premises. London, British Medical Association 2006
4. Chambers M. Scottish general practitioners’ willingness to take part in a post-retirement retention scheme: questionnaire survey. BMJ2004;328:329.
For more information:
BMA Scotland Public Affairs Office
Tel: 0131 247 3050/3052
Email: press.scotland@bma.org.uk