Unreal manpower planning. It’s too late for a decade. GP services face ‘retirement crisis’. It’s the shape of the job silly.

Unreal manpower planning. It’s too late for a decade. It’s the  shape of the job silly. If you put resources into training individuals to a high level of critical ability, and then give them a “straightjacket” of a job, you will get little freedom for personal choice other than going part time or emigrating – or retiring..

The shape of a job

BBC news’ Nick Triggle reports 15th April 2015:  GP services face ‘retirement crisis’ and their reporter implies that this is a surprise. Increasing criticism of the “new contract” and QOF has been in the public domain for many years, with pressure building in the form of poor recruitment, less time to see and care for patients, and generally an over-managed service. It might be that the next government needs to start again and return to the old contract and the “Red Book”.

I have a copy preserved in posterity if they have lost it! Rationing by deliberate undercapacity, short termism, overweight in females, undergraduate rather than graduate entry, ignoring the demographics, and the fact that educational standards are so much higher in cities that most medical students are city aspirants, does not help.

“GP services are facing a crisis, with a third of doctors considering retirement in the next five years, a British Medical Association poll suggests.

The survey of more than 15,000 UK GPs also found over a quarter were considering working part-time.

And one in 10 said they were thinking about moving abroad.

BMA GP leader Dr Chaand Nagpaul said the findings showed some of the promises being made about doctors by politicians were “absurd”.

Improving GP care has been one of the major themes of debate in the election, with the Conservatives promising seven-day access to services and Labour pledging a 48-hour waiting-time guarantee.

The findings are in the second tranche of results from the BMA’s poll of GPs, in which nearly a third of doctors in the UK took part.

Last week the BMA released figures suggesting excessive workloads were harming care. This batch of results focused on the effect those rising demands were having. It suggests:

  • 34% of GPs are considering retiring from general practice in the next five years
  • 28% of those working full-time are thinking about moving to part-time
  • 9% are considering moving abroad
  • 7% are considering quitting medicine altogether

They also cited various factors that had a negative impact on their commitment to being a GP, including:

  • excessive workload – 71%
  • un-resourced work being moved into general practice – 54%
  • not enough time with their patients – 43%
  • DrNagpaul said: “This poll lays bare the stark reality of the crisis facing the GP workforce.”It is clear that incredible pressures on GP services are at the heart of this problem, with escalating demand having far outstripped capacity.”GPs are overworked and intensely frustrated that they do not have enough time to spend with their patients.”In this climate, it is absurd that in the recent leaders’ debate, political parties were attempting to outbid each other on the number of GPs they could magically produce in the next Parliament.

    “Since it takes five to eight years to train a GP, it is not possible to create thousands of GPs in this timeframe.”

    Katherine Murphy, of the Patients Association, said: “We know from the many calls to our helpline that patients are not able to access GP services at times when they need to.

    “What patients want is a clear and firm commitment that GPs now and tomorrow will have the resources to meet their needs.

    “Anything less is just not acceptable.

    “We need a 21st Century primary care service with access 24/7.”

    But a spokesman for NHS England said measures were being put in place to recruit extra GPs through the recently developed workforce action plan.

    He said: “NHS England has invested £10m to kick-start the initiatives in the plan, which include incentives to recruit newly trained doctors into general practice, schemes to retain GPs thinking of leaving the profession and a new induction and returner scheme to encourage more GPs to return from to work after a period of absence working abroad or from a career break.”

    There are currently 9,000 GPs in training, although 14,000 doctors – about four in 10 – are over the age of 50.

  • Reality Check: Have GP services got worse?Nick Triggle: Is there really a GP crisis?

 

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This entry was posted in A Personal View, General Practitioners, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

2 thoughts on “Unreal manpower planning. It’s too late for a decade. GP services face ‘retirement crisis’. It’s the shape of the job silly.

  1. J Evans

    Br J Gen Pract. 2012 Dec;62(605):e851-8. doi: 10.3399/bjgp12X659330.
    Reasons why doctors choose or reject careers in general practice: national surveys.
    Lambert T1, Goldacre R, Smith F, Goldacre MJ.
    Author information
    • 1UK Medical Careers Research Group, Department of Public Health, University of Oxford, Oxford. trevor.lambert@dph.ox.ac.uk
    Abstract
    BACKGROUND:
    Less than one-third of newly qualified doctors in the UK want a career in general practice. The English Department of Health expects that half of all newly qualified doctors will become GPs.
    AIM:
    To report on the reasons why doctors choose or reject careers in general practice, comparing intending GPs with doctors who chose hospital careers.
    DESIGN AND SETTING:
    Questionnaire surveys in all UK medical graduates in selected qualification years.
    METHOD:
    Questions about specialty career intentions and motivations, put to the qualifiers of 1993, 1996, 1999, 2000, 2002, 2005, 2008, and 2009, 1 year after qualification, and at longer time intervals thereafter.
    RESULTS:
    ‘Enthusiasm for and commitment to the specialty’ was a very important determinant of choice for intending doctors, regardless of chosen specialty. ‘Hours and working conditions’ were a strong influence for intending GPs (cited as having had ‘a great deal’ of influence by 75% of intending GPs in the first year after qualification), much more so than for doctors who wanted a hospital career (cited by 30%). Relatively few doctors had actually considered general practice seriously but then rejected it; 78% of the doctors who rejected general practice gave ‘job content’ as their reason, compared with 32% of doctors who rejected other specialties.
    CONCLUSION:
    The shortfall of doctors wanting a career in general practice is not accounted for by doctors considering and rejecting it. Many do not consider it at all. There are very distinctive factors that influence choice for, and rejection of, general practice.

    J R Soc Med. 2012 Jan;105(1):25-34. doi: 10.1258/jrsm.2011.110146.
    Why UK-trained doctors leave the UK: cross-sectional survey of doctors in New Zealand.
    Sharma A1, Lambert TW, Goldacre MJ.
    Author information
    • 1UK Medical Careers Research Group, Department of Public Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK.
    Abstract
    OBJECTIVES:
    To investigate factors which influenced UK-trained doctors to emigrate to New Zealand and factors which might encourage them to return.
    DESIGN:
    Cross-sectional postal and Internet questionnaire survey.
    SETTING:
    Participants in New Zealand; investigators in UK. Participants UK-trained doctors from 10 graduation-year cohorts who were registered with the New Zealand Medical Council in 2009.
    MAIN OUTCOME MEASURES:
    Reasons for emigration; job satisfaction; satisfaction with leisure time; intentions to stay in New Zealand; changes to the UK NHS which might increase the likelihood of return.
    RESULTS:
    Of 38,821 UK-trained doctors in the cohorts, 535 (1.4%) were registered to practise in New Zealand. We traced 419, of whom 282 (67%) replied to our questionnaire. Only 30% had originally intended to emigrate permanently, but 89% now intended to stay. Sixty-nine percent had moved to take up a medical job. Seventy percent gave additional reasons for relocating to New Zealand including better lifestyle, to be with family, travel/working holiday, or disillusionment with the NHS. Respondents’ mean job satisfaction score was 8.1 (95% CI 7.9-8.2) on a scale from 1 (lowest satisfaction) to 10 (highest), compared with 7.1 (7.1-7.2) for contemporaries in the UK NHS. Scored similarly, mean satisfaction with the time available for leisure was 7.8 (7.6-8.0) for the doctors in New Zealand, compared with 5.7 (5.6-5.7) for the NHS doctors. Although few respondents wanted to return to the UK, some stated that the likelihood of doctors’ returning would be increased by changes to NHS working conditions and by administrative changes to ease the process.
    CONCLUSIONS:
    Emigrant doctors in New Zealand had higher job satisfaction than their UK-based contemporaries, and few wanted to return. The predominant reason for staying in New Zealand was a preference for the lifestyle there.

    Reply
  2. Pingback: NHS reality. An NHS soapbox. Speakers' corner for the NHS.

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