General practice in meltdown. “You never value what you have until you’ve lost it”…. or you will miss us when we have gone..

Des Spence in the Journal of the RCGP opines: General practice in meltdown.


General practice is in crisis. (But ministers are in denial) One in three training posts are empty, 1.10% of GP positiona are unfilled, and this is worsening daily. Practices are closing lists but this is deflecting pressure elsewhere, and with 25% of male GPs (many full time) over 55, the pressure is set to worsen. But there is no cavalry overthe horizon. This situation has nothing to do with “the Tories”, nor thew nastiness of the Daily Mail; it’s roots lie elsewhere. There has been a big expansion in hospital consultant numbers, 40% in a decade. With  increasing opportunities to work part time, currently 38% of female consultants choose to do so. The pay is good and there are opportunities to work privately, do research, attend conferences, and move into teaching and management. Out-of-hours work is much less onerous than before and consultants are shielded by junior staff. Hospital medicine is thus an attractive career. General practice has changed little, with only a 16% expansion in numbers: 10 minute appointments, an excess of 30 patients a day, uncertainty, accessibility, and a chaotic working environment. Working in small and often dysfunctional groups, sickness absence can make the workload unmanageable. New GPs can either become a partner with all the headaches that this entails or take a salaried position with all the limitations that entails.

General practice is an undervalued, deadend, and unattractive career for many.

But there is a fundamental professional issue limiting GP recruitment. In England in 2012, 29% of students were privately educated and a further 22% came from selective grammar schools. In Scotland in the same year, only 4.3% of medical students came from the poorest 20% of postcodes and 86% have parents from a professional group5. We are a profession choosing those in our own image. Medical School’s attempts at social inclusion are mere tokenism and we are wasting talent. The truth is, a medical degree is often about middle-class aspiration and this is killing general practice. Deans shamelessly promote an obsession with status, telling medical students not to ‘fail and become GPs. These pernicious negative attitudes against GPs are everywhere. Our hospitals echo to the sound of patronising laughter directed at GPs and doctors are not choosing general practice due to its low status. Are medical schools failing general practice and choosing the wrong people? Is there a solution? More money might help with general practice, if receiving a meagre 7% of the NHS budget can’t recruit GPs then what difference will more money make? More nursing support would help but there is a limit on how much medical work can be substituted by nurses. Fundamentally, GPs need a better working environment and more opportunities. A radical restructuring with bigger and better organised practices, and units of 30 000– 50 000 patients, is needed. This will afford economies of scale, diversification in careers, standardisation, and less chaotic working. We must also challenge the institutional negativity towards GPs in medical schools and hospitals. GP trainees completing foundation years should train exclusively within general practice. Hospital placements are frequently clinically irrelevant to general practice and general practice specialist training should be the same length as other specialists. We need more GP academic departments, more involvement in undergraduate training, and all foundation-year doctors should rotate through general practice. We also need a large expansion of medical student numbers, with affirmative action on social mobility. Medical student places have a limited supply and high demand, thus artificially elevating its status. Yet medicine is not especially academically challenging and there are plenty of suitably qualified applicants. You never value what you have until you’ve lost it. A collapse in primary care wouldn’t just be bad medicine, but a calamity for the NHS.

Des Spence,

GP, Maryhill Health’ Glasgow

BMA News 7th May Ministers in “denial” over NHS crisis



This entry was posted in A Personal View, General Practitioners, 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.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s