From March 2016 to March 2017, the total number of FTE (full time equivalent) GPs fell by 678 (-2.3%). Not enough doctors are choosing general practice as a career and many GPs are reducing their time commitment or leaving altogether. This is in response to rising workloads and the NHS pay cap since 2011 that has compounded a real terms decrease of more than £31,000 (23%) in GP’s pay in England since 2005/06. General practice is consequently experiencing one of the most severe recruitment and retention crises in decades. In addition, many of the workforce schemes in England are based on role substitution rather than an expansion of the general practice workforce. Time-limited funding for these schemes provides little or no long-term sustainability.
Source: NHS Digital General and Personal Medical Services, England as at 30 June 2017, Provisional Experimental statistics (August 2017)
Patients are waiting longer for appointments to see a GP while practices are unable to recruit GPs or nurses with many carrying long term vacancies. Growing numbers of practices are either closing their lists to new registrations, in order to manage their existing population safely, or closing altogether resulting in the loss of a local GP service for some communities.
- Government must establish a workforce strategy based on a genuine expansion of a multi-disciplinary workforce that is recurrently funded.
- Establish a retention scheme for GP partners that encourages them to remain in the profession.
- Utilise existing CCG recurrent resourcing, both financial and human, to support workforce expansion within practices and localities, shifting management resource to support direct patient care as CCGs merge and focus primarily on commissioning.
- Provide a national definition for multi-disciplinary locality teams working to support general practice, with built-in flexibility for different localities, so that patients in all areas of the country can consistently access a fully staffed community based healthcare team.
- Remove the differential for maternity and sickness reimbursement between GPs and practice staff.
- Provide direct access to community physiotherapy schemes for every practice.
- Secure full recurrent funding for pharmacists for every practice.
- Commission an expansion of the Improving Access to Psychological Therapies (IAPT) service with mental health therapists linked to every practice.
- Establish Child and Adolescent Mental Health services (CAMHs) linked to every practice.
- Fund an expansion of community nursing services aimed to directly support general practice.
- Provide training grants to support the training of nurses and allied healthcare professionals in general practice settings.
- Increase funding and decrease bureaucracy for the GP returners scheme, and ensure accessibility for GP partners.
- Further support for funded training programmes for doctors from disadvantaged areas.
- Improve opportunities for flexible working and promote portfolio career options.
- Ensure that increasing demand for flexibility is factored into future workforce planning.
- Design a holistic strategy to utilise and engage with salaried and locum GPs as a key element of the GP workforce.
- Establish comprehensive occupational health services freely accessible for all primary care staff.
- Secure full recurrent funding for practice manager training, and to support practice manager networks.
- Establish an ongoing commitment to the international recruitment of GPs that includes a structured induction and mentoring scheme.
- Create stability in the workforce by granting permanent residence to all existing EEA doctors currently working in the UK.
- Add General Practice to the Migration Advisory Committee’s Shortage Occupation List.
- Work with the profession to promote careers in general practice.
Outcome for patients
A clear, recurrently funded workforce strategy based on a genuine expansion of multi-disciplinary teams, could provide significant benefits for patient experience. With the potential for easier, more appropriate access to the care they need when they need it, this would significantly reduce the number of visits patients would have to make to see their GP.
Evidence suggests that clinical pharmacists can improve access to healthcare, improve patient safety through a reduction in hospital admissions and consequent adverse effect of medicines, and reduce medicines wastage and overuse.
Recurrent funding (whether from CCGs or national streams) is needed for practices, either singly or working with others in a locality, to enable patients to benefit from better access to other clinicians, such as physiotherapists and mental health therapists. This has potential to reduce the need for patients to make multiple visits to different care sites, a reduction in the number of overall GP appointments, and enable working adults to avoid unnecessarily prolonged sick leave. In addition, proper investment in the workforce, dealing with workload pressures that risk making clinicians themselves unwell and putting in place strategies that make them feel valued and supported, is likely to lead to greater retention of staff resulting in more continuity of care for patients.
Next: Sustainable indemnity
Saving general practice
With an insufficient workforce, a funding plan that is no longer sustainable, a growth in population and a sea-change in the level of complex cases being presented, urgent steps need to be taken to save general practice.