GPs have been the “jewel in the crown” that has made the Health Services Cost-Effective up to 2001. The evidence from emergency departments and A&E is that since then, more and more admissions are being made as a percentage of those seen. One of the solutions is to free up GPs to help out in these departments, but they need to be experienced and it is often the least experienced GPs who do these jobs whilst awaiting a practice/partnership. The jobs are less popular because there is no continuity of care, and because of the shift patterns.
In the last two decades the number of women GP trainees has increased dramatically as a proportion of the whole, but the whole time working equivalent has not. (Owain Clarke for BBC Wales reports 19th November 2013: ‘Crisis’ GP service ‘on its knees’, senior doctor claims). General Practice is more and more a female occupation. Many of these doctors work part-time whilst they have children. Sometimes they become full-time after the kids have left home. Making these GPs do weekend and evening/night work will not go down well… but it may have to happen as the current situation is not sustainable (Financial Times – Nicholas Timmins 19th June 2013). Many of the older GPs (such as myself) are choosing early retirement (Pulse 8th April 2013) so the problem is going to get worse…
The GP recruitment website informs doctors aspiring to General Practice how to apply. There are recruitment pathways in each Deanery, of which Scotland, Wales and Northern Ireland are examples. There are actually 17 Deaneries including the “Armed Forces”.
“A report (Kings Fund) has highlighted that the looming shortage of GPs and the oversupply of hospital specialists will undermine the drive to safeguard the NHS in the future…….
..The report comes after Pulse revealed deaneries have recruited only 95 additional GP trainees to begin training next month, (August 2013) casting serious doubt on whether Health Education England will reach its target of an annual intake of 3,250 GP trainees by 2015.
The think-tank says the workforce needed to be rebalanced to drive down future costs and prepare for the future needs of the NHS. It recommends a review of new national NHS contracts and a redistribution of the healthcare training budget.
Statistics released in March by the Health and Social Care Information Centre showed that the number of GPs had increased by just 25% since 2002, further compounding fears of a workforce crisis as the increase in consultants had risen by 49% over the same period,
The document said: ‘There is a mismatch between the location of the current workforce and where care is needed… The Centre for Workforce Intelligence, the national workforce planning body in England, is forecasting an oversupply of hospital doctors and an undersupply of GPs… Workforce redesign is needed not only because of a potentially dwindling workforce, but also because the nature of health care work is changing and the skills of the current workforce are not well matched to future needs.’
It concluded: ‘There is currently a real risk that the workforce, in particular the medical workforce, will drive the care model not the other way around. To achieve better alignment between the workforce and the work, workforce and service redesign need to go hand in hand. There should also be a review of current national contracts and pay.’
We need 10,000 more GPs, and more “generalists” with experience at the front line of the different health services. They need to be distributed differently and the Human Rights legislation does not help. Regions such as Wales are unable to “tie down” the doctors whose training they subsidise so that they work for a minimum of say 5 years in Wales – or buy their way out by returning the training monies. With a net loss of 20% of graduates, Wales and Scotland are in a poor position for recruitment compared with England unless they can keep doctors in the region whilst they form relationships and settle down. The RCGP has a vision of the future …. and provides evidence for more generalists, but it does not include “tie downs”, or address the mal-distribution. The awesome nature of being a competent generalist is a post on NHSreality. It would be better to train an excess of doctors… The debate goes back to 2005, when Pulse reported: Protect and value the role of the GP generalist. By removing the “emergency care” commitment the new contract from 2001 degraded the GP into a “chronic disease manager”, deskilled him/her for emergency care, which is what patients “fear” for. They do not fear complications of chronic diseases nearly as much …
A new GP contract is needed which encourages recruitment, and also for GPs to do emergency care. In rural areas this is particularly important. It may not be popular with part timers. Will the meetings of Local Medical and Commissioning Groups going on as this is posted, be able to see past the threats to local hospitals, and see the leadership opportunities for generalists which arise if they become the mainstay of emergency care? Patients may have to travel more if they are referred, but if outcomes are better and the service is more efficient it will be well worth it. One of the main issues is transport links, and without air ambulances running 24/7, remote areas without fast roads will have poorer outcomes until those roads are built.
But why not use rationing by co-payments and prescription charges (Wales and Scotland) to reduce demand? Listen to both Mr Bill Clow and Mr Jon Skone in their recent interviews….
19 March 2005