'Unclear' how GP services can be maintained in face of workforce crisis, warns DDRB

It is unclear how general practice services can be delivered five to 10 years from now given the growing workforce crisis facing the profession, the independent doctors and dentists review body (DDRB) has warned.

The pay review body's warning is a stark reminder of the depth of the workforce crisis facing UK general practice, highlighting the ageing workforce and increasing tendency towards salaried and part-time working.

The DDRB highlighted the 'particularly precarious' situation in Northern Ireland, where GPs are on the brink of mass resignation, and the trend towards salaried GP roles at a time when new care models are increasingly being adopted as key concerns for general practice.

The DDRB report warns: 'A large number of GPs are over 50 and may be considering retirement in the next five to 10 years.

'Comparing this with the number of GP registrars and the increasing numbers choosing salaried GP work, it is unclear to us how the work will be covered – there will be fewer GPs in total, and fewer who want to become partners.'

GP workforce

The report adds that the government's ambition of becoming self-sufficient in terms of medical graduates by 2020 is 'sensible', but warns that 'we are not yet convinced that the mechanisms are in place to achieve this – particularly given changing demographic trends, such as the feminisation of the workforce and ‘Generation Y’ preferences for greater work-life balance and flexibility'.

General practice in the UK faces a 'serious situation', the report warns, pointing out that 'GPs are very concerned by increasing demand and workload pressures, with many feeling the situation is unsustainable'.

The latest GP workforce data published by NHS Digital show that the total number of full-time equivalent (FTE) GPs fell by almost 100 over the year to September 2016.

GPC deputy chair Dr Richard Vautrey said at the time that the figures showed 'the crisis in general practice is getting worse not better'. Both the RCGP and BMA have since hit out at plans that could stretch the workforce thinner by setting up GP-led triage in every A&E department in England by this Christmas.

The government has pointed to its ongoing drive to recruit more GPs - and figures from Health Education England (HEE) earlier this year suggested a rise in numbers of doctors applying for GP specialty training - but the DDRB warned that new recruits would not arrive in time.

The DDRB report says: 'Data on part-time working in new GPs suggested there may be 1,900 fewer full-time equivalent GPs in England by 2020 than HEE had estimated there would be. This could cause serious issues for both workforce planning and the delivery of primary care.'

Salaried GPs

The report says that the impact of growing numbers of women in the GP workforce will lead to 'a likely reduction in the amount of hours per head'. The report says female GPs are more likely to opt for salaried roles and to work fewer hours than their male counterparts, and that this must be planned for to avoid exacerbating the 'shortfall in the supply of GP services'.

The DDRB adds: 'There are signs of a clear trend in the GP workforce towards salaried employment and away from the contractor-partner model. It is not yet clear if this is a permanent trend.

'However, broader changes in the economy, particularly with the entry of the Generation Y cohort into the labour market imply that it might be. A systematic data collection exercise is needed to understand properly the profile of the GP workforce in terms of FTE, geographic, demographic data, and career choices.

'Understanding FTE would shed further light on how far Generation Y desires for flexibility are translating into part-time working patterns, crucial for effective workforce planning.'

The DDRB warns that NHS organisations lack 'data and insight' into the trend towards part-time and salaried GP working, warning that at a time of 'a significant amount of change in the primary care landscape' this could undermine workforce planning.

'There may be a lack of readiness for what may be a fundamental shift in the workforce, in terms of ensuring that the employment offer is as attractive as possible whilst maintaining value for money in primary care provision,' the DDRB warns.

It adds that salaried GPs are 'more likely younger and female than GP partners'.

'Despite generally lower earnings than partners,' the report says, 'a salaried role in general practice appears to be an increasingly popular choice for new doctors, which could be due to the greater flexibility and work-life balance this role can offer over partnership. Overall, there is insufficient evidence for us to draw firm conclusions, but we will closely monitor this group, as there could be implications for the future planning and delivery of primary care.'

The BMA has warned that advice from the DDRB that the 1% cap on NHS pay rises should remain in place for 2017/18 could drive up GP practice closures.

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