What does the 2019 general election result mean for GPs?

General practice is struggling with a workforce in decline, rising demand and a share of NHS funding well below the level GP leaders say it needs. GPonline looks at what the Conservative election victory could mean for the profession.

Westminster (Photo: Getty Images)
Westminster (Photo: Getty Images)

One of the first tasks for the newly-elected Conservative government will be to tackle the NHS workforce crisis triggered by the pension tax trap that has forced thousands of doctors - including GPs - to reduce their working hours or refuse extra shifts.

The Conservative election manifesto promised an 'urgent review' of the pension tax problem within 30 days if the party was elected - working with the BMA and the Association of Medical Royal Colleges (AoMRC).

The loss of capacity created by this tax trap has left some NHS services unable to function and is likely to have contributed to the loss of 340 full-time equivalent (FTE) fully-qualified GPs from the health service workforce over the year to September 2019.

Pension tax

An 'exceptional' move announced by NHS chief executive Simon Stevens last month saw the health service promise to pay off 2019/20 pension tax bills for doctors. But the move does not solve the tax trap in the long term and it remains unclear how it applies to GPs.

The BMA has said a 'review' falls well short of what is needed - but will now have to engage in the hope that it can secure a decision to scrap the tapered annual allowance mechanism.

The Conservative party has also promised to recruit an extra 6,000 GPs, along with 6,000 other primary care workers such as physios and pharmacists on top of the 'army' of 20,000 staff primary care networks (PCNs) are meant to recruit by 2023/24 under the NHS long-term plan.

The party has also promised to increase the number of GP training posts from the current 3,500 to 4,000 from 2021/22, and has said its plans would create an extra 50m appointments in general practice by 2024/25.

GP training

Plans for 500 more GP training places fall short of an RCGP warning that the NHS needs to train 5,000 GPs a year to make general practice sustainable.

The Conservatives have also yet to clarify whether the extra 6,000 GPs they are promising will be measured in FTE or 'headcount' terms. With many current GP trainees planning to work less than full time, clarity on this point is essential.

The success of PCNs in bringing in staff in additional roles to support general practice will be crucial over the coming years - although many GPs remain unconvinced that the networks will ultimately reduce their workload. GPs are also likely to be unconvinced that the government can deliver its promise to bolster their numbers by 6,000 - however this is measured - given the spectacular failure of the Conservatives' 2015 election promise to boost FTE GP numbers by 5,000 by 2020/21.

But an increase in capacity in general practice is particularly key given that the Conservatives have promised an extra 50m appointments by the end of the next parliament - a 16% increase on the 311m a year currently delivered by GPs, nurses and other staff in general practice.

This promised increase in appointments comes after Boris Johnson used his first speech as prime minister in July this year to promise to 'drastically reduce' waits for GP appointments.

GP access

BMA GP committee chair Dr Richard Vautrey said last month that 'so far political parties have listened to us and not included counter-productive access targets in their election statements'.

With a Conservative majority in parliament, the party may feel emboldened to push harder on access to GP appointments - meaning this could yet become a key battleground for general practice.

As for funding, the BMA has warned that investment in general practice is simply not meeting required levels under current plans. Under the NHS long-term plan the Conservative party is committed to a £20bn real-terms increase in NHS funding over the five years to 2023/24 - including an increase in funding worth at least £4.5bn for primary and community care.

But a BMA response to the Conservative election win says the government must go further - boosting NHS funding by 4.1% a year rather than the 3.4% promised currently.

GPs will also be watching carefully to see how the election result affects progress on other key areas for the profession. NHS England set out proposals this year on digital first practices, and a review that promised to reduce the burden of premises on GPs - while last year began with the publication of a report on GP partnerships which promised a string of measures to tackle the sharp decline in partner numbers in recent years.

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