Special LMCs conference: DH must wake up to the crisis facing general practice

Top GPs will debate the crisis facing general practice on 30 January at the first special LMCs conference in a decade. In the first of a series of articles from senior BMA GPs ahead of the emergency summit, GPC deputy chairman Dr Richard Vautrey spells out why the profession is struggling.

The calling of a special LMCs conference represents the deep frustration and rising anger that many GPs are feeling at the continuing crisis in general practice and the government’s failure to listen to solutions from grassroots GPs. This counterproductive approach amounts to ministers burying their heads in the sand – and it has to stop.

Motions submitted by LMCs are crystal clear about the twin and intertwined concerns: the strains on both patient care and overworked GPs. Indeed the opening motion states that the 'the intensity at which GPs are working' means that 'current working practices may be a risk to patients' care and GPs’ health'.

The factors behind this crisis have been clear for some time. GPs are facing a perfect storm of falling funding, rising workload, staff shortages and more unresourced work being transferred out of hospitals into the community.

At the same time politicians, especially during the recent election campaign, piled on ever more elaborate schemes for expanded GP services without answering the obvious question of where the GPs, the community staff and in particular the funding was going to come from to back up these promises.

GP crisis

Not only are GPs painfully aware of this situation on the ground, but increasingly the media and the public have been waking up to these problems. Last year a major BMA survey of over 15,000 GPs commissioned by GPC received wall to wall coverage for its conclusion that nine out of 10 GPs felt unmanageable workload was detrimentally impacting on patient care.

A third of GPs said they were considering retiring in the next five years, figures that were made even more worrying when later in the year more than 600 GP trainee vacancies were left unfilled. A few weeks ago, the British Journal of General Practice revealed that large numbers of GPs were taking breaks or leaving the profession because of burnout and stress, something backed up by the recent Commonwealth Fund report which made front page news this week.

Unfortunately as yet, the government has not offered a coherent plan to address these concerns. There have been some steps forward; the GP 10-point workforce plan that the BMA has worked with NHS England on has made some initial moves to promote general practice as a career and there has been some extra help for GPs looking to return to the profession after a break, following GPC lobbying.

In addition small amounts of funding has been used to support the greater use of pharmacists in a limited number of practices. But these schemes have been outweighed by the failure by the government and NHS England to deliver on premises funding, by proposals to hike CQC fees and to make no real changes to reduce GP bureaucracy or workload pressures by addressing the GP recruitment crisis, all themes to be discussed at the conference.

Sustainable GP contract

This conference reflects these concerns and solutions are offered. There are calls for 'an adequately resourced, safe and sustainable national core GP contract' based on a registered list and with 'personalised care being delivered by general practices supported by extended primary health care teams'.

Linked to that is the call for all practices to receive a minimum of £200 per patient, which would simply take us back to 11% of the NHS budget spent on general practice and which is the bare minimum we need to have a sustainable service that meets patients' needs. 

Further calls for longer consultations are welcome but can only be delivered if we get sustainable funding to expand the practice workforce, echoing much that was outlined in the BMA’s vision for general practice published last year.

This conference should be viewed by the government as an opportunity. It is a chance for them to listen to GPs, hear about the real state of GP services and most importantly finally take action to work with us to implement the constructive solutions GPs are offering. One obvious fact is clear from this conference: we cannot continue with a service that is struggling badly to provide even basic care to its patients - urgent action is needed, and needed now.

Photo: Alex Deverill

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