Will the doctor see you now?

Committing to a seven-day health service in the queen’s speech last week (May 27), the government echoed its manifesto pledge to provide GP access all days of the week from 8am to 8pm.

But behind the headline grabbing promises lies a crisis in general practice that’s quickly deteriorating.

Record numbers of GP surgeries are being forced to shut down, the Independent reported  yesterday (June 1), with 61 practices having been closed since April 2013, leading to more than 160,000 patients having to register elsewhere.

The situation is becoming exponentially worse, as figures have shown that between March 2013 and April of last year, 169 practices approached NHS managers for formal advice on closing. Just one year before, there were only 37 requests for closing advice.

In certain parts of the country, patients are feeling the GP crisis more acutely. In London, for example, 22 practices have shuttered, forcing more than 50,000 people to find new GPs.

Dr Robert Morley, of Birmingham’s Local Medical Committee, told the Independent that the situation now is “absolutely dire and getting much worse.”

“We have small partnerships that are becoming unviable because of issues of recruitment, retention, impossible workload, GP illness and ‘single-handers’ [GPs running a practice alone] retiring,” he explained. “Practices are also being closed by the Care Quality Commission.”

Profession in crisis

 

 

Cameron has said that pouring in more funding and recruiting new GPs will make it possible to provide guaranteed access to a GP seven days of the week by 2020.

But for those currently in the frontlines of the profession, it’s far from being that simple.

Because so many GPs must now contend with nearly impossible workloads, many are choosing to retire earlier. A recent survey by the British Medical Association (BMA) found that one in three GPs are considering retirement within the next five years.

This comes at a time when the GP workforce is predominantly older – the average age a GP retires is about 59. And the number of practices where all or most of the doctors are over 60 years old is an astounding 543.

Cameron has pledged a strong GP recruiting drive, but in the current climate, very few medical students are deciding to go into general practice. The government wants half of all medical graduates to become GPs but research has shown only 11 per cent of new medical students have planned a career in general practice.

Combine recruiting, retaining and retiring pressures with the massive funding shortfall many NHS services face, and a seven-day service becomes an ever more fantastical pipe dream — or as Dr Chaad Nagpaul of the British Medical Association called it, “a surreal obsession”.

A vicious circle

 

 

A full seven day GP service does sound desirable in theory – and may have even swayed some voters to cast their ballot in the Tories’ favour.

But Dr David Wrigley, a GP in Lancashire, told UniteLive that general practice – in the situation it’s in now – is simply not equipped to handle a seven day service.

“It’s not only that GPs are choosing to retire early – many are leaving the profession flat out,” he noted. “A colleague of mine recently quit altogether, and he’s in his 40s.

“Very few medical students are choosing general practice because they hear in the media how the profession is attacked. There’s this myth that GPs are overpaid, that they never work out of hours, but it simply isn’t true.

“It’s become a vicious circle, really,” Wrigley added. “GPs are leaving or retiring and no one is coming in to fill their posts. There was recently 400 unfilled vacancies for trainee GPs – that’s practically unheard of until now.”

Stretched

 

 

Wrigley argued that, coupled with a reduction in funding for general practice, a staffing shortfall would mean that spreading out services to seven days would be like stretching a rubber band.

“At some point, if you stretch a rubber band far enough, it’s going to snap.”

Wrigley isn’t against the idea of a seven-day service, but contends that “before you can have a seven-day service, you have to get a five-day service right first.”

“Funding needs to go up dramatically,” he noted. “Cameron says he wants to bring in 5,000 GPs but surveys have shown that one in three GPs are retiring in the next five years – that’s 10,000 GPs. With all the pressures that the profession is under, where exactly is he going to find these thousands of GPs?”

A logistical consideration that many politicians and voters may not realise would be required to implement a successful full week GP service is additional staffing and resources at all levels.

As Wrigley argued in a recent British Medical Journal article:

“As a GP if I see a patient on a Saturday or a Sunday, I need the full range of services available to me in order to treat my patients effectively. I need a fully functioning hospital laboratory with blood collection services twice a day over the weekend. I need access to NHS physiotherapy for my patients with urgent musculoskeletal problems. I need access to health visitors to refer children needing their input. I need access to a fully functioning radiology department offering x-rays, CT scans, MRI scans, ultrasound, and other investigations.”

“This, however, will cost billions,” Wrigley noted.

“A good doctor is a safe doctor”

 

 

Wrigley told UniteLive that he and his colleagues greatest concern is providing a safe and effective service, a concern which, as it stands now, is at odds with a full-week service.

“A good doctor is a safe doctor, and you aren’t a safe doctor when you’re overworked and under-resourced,” he said. “GPs’ objection to Cameron’s plans has nothing to do with our pay and everything to do with our concern for our patients.”

“Unfortunately, Cameron’s aim for a full-day service is more politically motivated than anything else.”

Wrigley’s sentiment was echoed by Unite general practitioners president Dr Ron Singer, when UniteLive first reported on the GP crisis last year.

“Warm words from badly informed politicians are not needed,” Singer noted.

“Urgent action is required to restore general practice back to a service we can all be proud of.”