GP crisis: Practices need workload cap and basic income guarantee

The challenges facing today's GP workforce are enough to make most consider retirement, argues NHS Alliance co-chair Dr Mark Spencer. But if the government is prepared to implement measures to limit workload and guarantee a basic income for practices, there is still time to save the profession.

The year 2016 marks two significant personal milestones: I reach the ripe old age of 55, and will have been a GP partner for 25 years. As a young doctor, I was fired up by life as a GP and thought that this was one of the best jobs in the world – huge variety, interaction with all kinds of people, and most importantly, the absolute belief that I might be able to transform lives for the better.

But 25 years later, GPs are leaving our profession in droves. Perhaps no surprise when all junior doctors hear is what’s wrong in GP world. And, to be fair, a lot is wrong.

Has the thought of retirement crossed my mind? Yes. How often? Every day for the past 18 months. Why? In simple terms, it’s workload, money and complaints.

GP workload

Our escalating workload doesn’t just affect morale, it’s the sense of not being in control. A sense of being completely overwhelmed to the point of feeling clinically unsafe. We are managing patients with multiple long term conditions, and increasingly complex needs. The NHS is now very fragmented, and valuable consultation time is wasted trying to organise the most basic of care. This is ridiculous. How many people do we really need to fit a hearing aid? And, in addition to managing routine workload, we must triage, at the very least, every single patient who contacts the practice for an urgent appointment or home visit. 

Secondly, money. Take home pay for many GPs has fallen by 20% over the past three years. The term ‘practice profit’ seems to infer, mistakenly, that we have a basic salary, and then take a ‘healthy’ profit on top. In reality, we pay our staff out of total income and then live on what’s left.

What really frustrates me and many other GPs is that Foundation Trusts, in deficit by billions, are bailed out with money earmarked for primary care. This is largely due to soaring locum and agency costs. The locum costs in my practice come out of my own pocket – no-one ever offers to bail me out.

Income is, at best, static while expenses are rising. The busier we are, the more staff we need. It’s simple. Every promise of increased income requires additional expenditure. More work for the same or less money. Demoralising.

Rising GP costs and complaints

Thirdly, complaints. Complaints and medico-legal issues are at an all-time high. Of course, GPs make mistakes, and should be receptive to feedback, but, we are an easy target when things don’t go right in the eyes of patients or carers. GPs care. Most of us will take each and every complaint personally, whether or not we feel we have done anything wrong.

So, can we make things better? I think we can. In fact, I think we must if general practice is to attract the passionate, talented and committed young doctors we so sorely need. My prescription would be:

  • Make workload defined, manageable and safe: introduce a daily maximum number of consultations, and define their length so they work for both GP and patient.
  • Address the current funding gap: we don’t need GP assistants, we need a simple minimum income guarantee so we can recruit and retain sufficient staff to match workload.
  • Crown indemnity to be provided to all GPs as a matter of urgency.
  • Direct support for managing complex patients and practice-based care co-ordinators to help people navigate the system.
  • Offer patients alternatives to ‘urgent’ appointments and home visit: interact positively and collaboratively with colleagues in primary care - reaching out to colleagues in pharmacy, eye care, housing and emergency services is high on New NHS Alliance’s agenda: people’s health improves when the NHS works with other agents who are key to the social determinants of people’s health.
  • Recalibrate our thinking and mindsets: focus on health creation.

So, am I thinking of leaving clinical medicine? Yes. Will I leave this year? No. Why not? Because I believe if we can get the above right, we can then harness our collective power to champion the career that I still believe is one of the best in the world. I know things can get better. And right now, there’s no one to take over from me if I were to leave. I care desperately about my practice, my patients and my community. They are second only to my family.

  • Dr Mark Spencer is a GP at the Mount View Practice, in Fleetwood, Lancashire and co-chair of the New NHS Alliance

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