The publication of GP practice closure survey by the BMA exposes the fissure that exists between the rosy rhetoric from politicians about what they are doing for general practice and the dreadful reality on the ground for the vast majority of GPs in England. It is now vital that the government bridges this widening gap before GP services slip even further into crisis.
The results from this survey paint a stark picture. Just over half of GP practices surveyed felt that the situation was so bleak they would consider closing their practice list temporarily to cope with the enormous pressures they are under. Around four out of 10 would take the further, even more serious step, of applying to NHS England to close their lists permanently. It is a tragedy that any practice is considering taking this step, but sadly we are already at the point where GP practices in England are shutting their lists in order to protect patient safety.
I have heard far too many stories about the dire circumstances in many surgeries that are under pressure from all sides. Some have to cope with dilapidated buildings that are too cramped to provide the range of services or even basic care that the community needs. Many face staff shortages across the practice team, with GP vacancies sitting unfilled for months on end (a third of GP practices told the BMA recently that they had spent 12 months trying to fill empty GP posts). Indemnity costs are crushing practice budgets that are already being squeezed by rising premise costs and stagnating funding.
Recently I have been leading on work aimed at helping practices reduce workload safely because many are completely overwhelmed by the endless flow of unresourced commitments that are being dumped on them by NHS managers. The fact the BMA has had to produce detailed guidance giving GP practices the ability and confidence to tackle this issue demonstrates the extent to which this has become a problem.
And of course these problems affect all GPs, whether they are partners, salaried, locum or trainees. Every part of the workforce is feeling the personal pressure as well as the overall pressure as a team: indemnity costs in particular are bearing down on individual’s finances and forcing many to reduce their sessions or consider exiting the profession altogether, adding to our workforce woes.
That is not to say there hasn’t been some signs of relief in the past few years. GPC has won reimbursement for unfair CQC fees, cut paperwork requirements via the annual negotiations and brought an end to the emergency unplanned admissions DES. After intense lobbying the government agreed to accept the provisions of the BMA’s Urgent Prescription for General Practice in the GP Forward View.
But while there has been movement in public, there has been sporadic traction on the ground. A good case in point is the promised extra funding for GP premises. This money, desperately needed in many cases, has arrived in some areas, but overall the implementation has been sporadic and uneven, the application process an administrative nightmare and now uncertain about whether all the funding will actually be spent. This is just one example of how the warm, positive words in the media and emails from NHS England have ended up being a far less shiny reality for GPs.
This new survey should be taken as a direct warning from general practice by ministers. Although we currently have a government badly distracted by Brexit, they cannot take their eye off the ball in the NHS: they must realise that nodding their head and agreeing that there is a problem is not the same as solving it. As we move into winter, we need politicians to push for a comprehensive, fully resourced plan that is properly, and consistently, implemented across England so that patients finally, after years of waiting, again get the service they deserve.