The BMA’s latest survey demonstrates the enormous pressure that grassroots GPs are facing. It also shows that some of the answers to these problems lie not in political diktats from central government, but in common sense solutions from GPs working in local practices.
The major survey of more than 5,000 GPs across England gives a picture that many GPs will find familiar. More than eight out of 10 believe their current workload is excessive or unmanageable. By region there is little difference between the nine geographical areas, the lowest number of GPs feeling their workload is damaging is 83%, the highest 86%. This shows that every corner of the country is buckling under the same challenges that for far too long have been left to fester.
The lack of investment from successive governments of general practice has been allowed to happen at the same time as rapidly rising demand for services, while staff shortages and more care being transferred into the community have resulted in even more stress within the system.
Numerous political projects have crashed disastrously and wasted even more time and billions of pounds that should have been spent on patients. The massive reorganisation of the health service, major failures of big IT projects, the shambolic launch of NHS 111, the unfairly expensive CQC inspection and regulatory regime and the chaos in the patient record system owing to an inept service from Capita: all these in their own ways have been distractions that general practice has not needed.
There have been further challenges in the background that have further chipped away at the ability of general practice to deliver a safe and high quality service.
A key example relates to how we cope with an ageing population living longer. This is of course a good thing and a direct result of GP interventions that improved the quality of life of many patients and led to more people living long into old age.
But the longer a patient lives, the more care they need, and the more complex it becomes. This intricate support was once managed by hospital specialists but now much is done by GPs and their teams. Patients are spending shorter time in hospital and discharged much sooner after procedures and interventions, yet still need significant care once they get home.
Primary care teams
I’ve been hearing from GPs across the country for years how their previous primary healthcare teams have been dismantled and become more remote. Where once practices knew their district nurse and health visitor, now they rarely see them or have to communicate by email or centralised anonymous calls centres. Community nurses have moved away from direct links with practices and centralised in to geographical teams.
This is recognised by GPs in our new survey. They have told us clearly that they see it as essential to rebuild this primary healthcare community team and add to it with a wider group of professionals. The same is true for other areas: more mental health workers to help deal with the surge in demand in this area and greater emphasis of self-care that helps patients deal with minor ailments that can be safely treated without a visit to a GP.
The GP Forward View does accept many of these contentions, not least as it explicitly agrees to the principles to those laid down in the BMA’s Urgent Prescription for General Practice. But many GP practices have failed to see any real improvements on the ground, and on areas like more community team support the GP Forward View is silent while warm in principle.
This survey should be a perfect wake-up call to ministers that now is the time for them to act. Implementation and not more promises is what general practice needs in 2017.
- Dr Richard Vautrey is GPC deputy chair and a GP in Leeds