There is little doubt that 2017 was another tough year for GP practices throughout England as many had to cope with 12 months of increased pressure from rising workload, tightening budgets and continued staff shortages.
However, amidst the gloom there were signs that politicians were finally appreciating the depth of the crisis facing general practice, and more importantly beginning to take action. The test for 2018 will be whether the positive contract agreement we secured this year can be built on and whether positive words can be turned in to practical action to enable a rapid response that helps badly overstretched GP services.
It is with this in mind that the BMA has produced a new roadmap for the future, Saving General Practice. The crisis facing GP services has increasingly moved to the top of the media and public agenda, partly owing to the work done by organisations like the BMA.
Highlighting the problems is one thing, but now we are coming forward with solutions. The GP Forward View commits to an additional investment of £2.4bn by 2021, but it has proved too complex and all too often lacks the long-term commitment of recurrent funding needed for practices and localities to plan for the future.
We have though secured agreement that has meant that for the first time practices’ CQC fees would be fully reimbursed and in addition received funding to cover the in-year in the crippling cost of indemnity. Furthermore, just a few weeks ago we agreed with government that they would put in place a state-backed indemnity scheme for all NHS GPs and their practice teams, something that would be a significant step forward. We have also seen a welcome expansion of the targeted GP recruitment schemes for GP Trainees.
These moves are welcome and have made a difference, but we now need to see much bolder and longer-term solutions, rather than short-term fixes. A programme to save general practice starts with the recognition that the current funding for GP services as a proportion of the overall NHS budget, which stands now at just 7.6%, is far too low.
This is at a time when there are a growing number of older patients with complex conditions who want and need more time, more often, with their GP. We are currently £3.7bn short each year of reaching the BMA’s target of 11% which we believe should be a baseline of what the profession needs. Shortages in GPs remain endemic, and while GP trainee applications are up, the overall GP workforce shrank by as many as a 1,000 in the latest figures. Morale remains low as workload remains high as the same time as pay packets are squeezed.
This situation cannot be allowed to continue. At the centre of Saving General Practice is a call for a wider plan that reaches beyond putting sticking plasters on a cracking service. We need a concrete workforce strategy that plans for the future with a clear set of goals for recruitment and which is tied with a wider approach to increase recurrent funding.
We put forward many other solutions, from encouraging more informed self-care to dealing with the problems of premises and IT infrastructure. However the key is to ensure the £3.7bn gap is plugged for us to stop GP practices disappearing, lists being closed and patients queuing for appointments.
There are signs of progress, but GP services have fallen so far into crisis that we cannot afford to sit back in 2018. Politicians and NHS managers may well have got the message that general practice is buckling under unsustainable pressure: now they need to act, and act fast, to deliver the improvements needed to save general practice. We’ve provided them with the plan, now they need to work with us to deliver it.