“Nobody can get a GP appointment these days”. “You never see the same person twice”. “It’s always someone who is not a proper Doctor I see now” .
These are common worries people have about their local surgery; but political pledges such as “To see a GP within 14 days” are no use without fundamental change to how primary healthcare is provided.
Incremental changes to GPs’ working practices mean that today many younger GPs are understandably content working part-time and less inclined to work in a permanent role, particularly when they can earn far more as a locum with greater flexibility. Doctors – like other professionals – have become more comfortable changing location and career path. Most do not want to be GP partners (with all the administrative burden that brings) working in one place for their whole career as they once did. Not only are older GPs quitting but 20% of fully-qualified GPs under 30 left in 2022, and more than one in 10 (11.4%) of fully-qualified young GPs aged between 30-35 quit over the same period.
We are training more GPs, but this is not translating into more GPs on the ground. So why are we losing so many GPs? There are three main reasons.
First, workload and stress are often cited as the main reasons for a GP career being unattractive. Demand for appointments in primary care has been rising over the years and accelerated post Covid. The reasons for this are complex and a subject for another article but this certainly adds to stress.
Second, many GPs feel powerless. The system makes caring for patients difficult. It is hard to obtain specialist advice because the GP and consultant don’t know each other and there are many hurdles to contacting consultants. Accessing tests often requires multiple referral criteria and then waiting to provide an appointment – and GPs cannot even tell patients how long they will wait. So rather than trying to manage patients in-house, GPs just send a hospital referral letter – despite knowing the potential length of a wait.
Third, there are the mandatory training requirements and appraisals. Do GPs really need training on fire safety, equality and diversity, radicalisation, infection control, manual handling, data security annually? Additionally, the GP annual appraisal is a long-winded process which ties up considerable time and expense in preparation. It is something GPs want to get through and doesn’t have any impact on patient care and debatable educational value.. The Government could make the mandatory requirements consistent and mandate these and appraisals every three years rather than annually. It would save money, have no adverse effect on patients and improve retention.
Rather than pretending that we can go back to family GP partnerships or even try to put people in front of any GP within 14 days we should accept the reality. We are simply not going to have enough GPs to go round unless we update how we ask GPs to deliver primary care. It is time to formalise and accelerate the changes that are happening already. Many people attending surgeries do not actually need to see a doctor; other clinicians are better suited to dealing with their problems, and some patients have administrative problems but currently end up seeing a clinician as a default. We should be trusting people and GPs’ professional staff to agree what services are needed.
We do of course need GPs – but we should create an exciting, varied, progressive career adapted to the modern needs: a new GP-Consultant hybrid role
In this new role doctors specialising in an area such as dermatology, cardiology or diabetes would see patients with more complex medical needs. They would see fewer patients for longer, and spend the rest of their time coordinating care, supporting and teaching the rest of their team and making decisions about local services.
GPs and other parts of the NHS have tentatively experimented with this over the years but never considered it as a formalised career.
Primary care organisations should be given free rein to develop an innovative suite of services for their patients – responding to local demand, innovating using their experiences and knowledge, and delivering bespoke, appropriate care. These new GP-consultants could choose to be an integral part of this, freeing them up to deliver healthcare rather than administration.
Without rapid change there will be very few GPs left and we’ll struggle to meet the needs of our patients.
Dr Paul Charlson was a full-time GP but developed a portfolio career many years ago. He still works regularly in an inner-city practice.