General practice is in a 'complete mess', warns former RCGP chair

General practice is in its worst state since the 1970s and needs fundamental change through a new 'charter' to tackle problems with pay, doctors' safety, premises and the GP contract, a former RCGP chair has warned.

Professor Clare Gerada (Photo: Pete Hill)
Professor Clare Gerada (Photo: Pete Hill)

Former RCGP chair Professor Clare Gerada said on Thursday: 'It’s a complete and utter and total mess - we have a locum market where a locum can earn more than a partner. Young doctors going out straight from vocational training into a space that is not very safe for them.

'You’ve got a system where it is virtually impossible - because you own your premises - to retire, you have a QOF that is dictated by medicines. Continuity of care is nowhere at all in our contract - how we deliver continuity - while we know it is the single most important factor for patients.'

Speaking at a Westminster Health Forum event in central London, the former RCGP chair said 1,500 GPs had received support from the Practitioner Health Programme PHP) - a mental health and addiction service she set up and works in as medical director. 'Practice meltdown' was a leading cause of GPs seeking help for depression, she told the conference - often doctors unable to cope after the departure of two or three partners who they simply could not replace.

Mental health

One in four doctors coming forward were 'in their first five years of training', she added - after being forced to take on 'too much, too soon' - often struggling to cope with managing high levels of uncertainty working as locums, a role considered among the hardest in general practice in past generations.

Professor Gerada rowed back slightly from her earlier comments, saying the situation facing general practice was 'not a total mess', but added that the profession needed a 'fundamental new contract and new charter for primary care and our relationship with patients and the NHS'.

She told the conference: 'The time general practice was last in this state was about the 1970s - and what our leaders did then was create a new charter for general practice, which actually defined what GPs should do, how they should do it, how they should practise and all sorts of other issues.

'I think we now need a new charter,' Professor Gerada said.

The London GP said that although the NHS had the Five Year Forward View policy document providing direction, she felt it didn't 'address us in general practice'.

GP contract

She added: 'I think we have  to start looking at our contract, it’s far too rigid, it dictates how many patients we see in our consulting room, so we can’t give longer appointments because we don’t meet the requirements of the number of patients in the contract So I think we need a new charter, with all of us creating that, and hopefully it could sustain us for another 40-50 years.'

GPonline reported this summer that the NHS GP Health Service - run by PHP - currently has around 1,200 GPs on its books.

'There is no future of general practice if we don't have GPs - so we have to have GPs who are well,' she Dr Gerada told the event. But she warned that there was a form of 'magical thinking' going on in the NHS.

'We have a workforce that is at the extreme of distress - depression, anxiety and a new diagnosis called NHS-itis. We have more and more patients required to be seen by this workforce with more and more complex issues and yet the workforce isn't there. And in this magical thinking, we just think well, we won't do anything about it.'

Of the 1,500 GPs seen by PHP services, two thirds have mental health problems - depression, anxiety and post-traumatic stress disorder. 'Probably about 10% have some sort of addiction and the rest other issues,' Dr Gerada said.

Doctor stress

She said two major factors were driving up stress for doctors - the rising numbers of complaints and the lack of space in which to reflect. Patients were constantly encouraged to complain, she said - through footnotes on NHS correspondence and in other ways - but these complaints could have a 'devastating' impact on doctors.

Dr Gerada called for a new 'code of conduct' to make clear to doctors what would happen when a complaint was received, and called for steps to 'declutter' GPs' working lives by easing the burden of mandatory and statutory training, which could take up around 30 hours a year for GPs.

More of this training should be carried out in groups - she added. She told the event she had recently carried out her own mandatory child safeguarding training. 'I cannot believe who on earth thought it was a good idea on such an emotive issue to expect somebody - and I am pretty robust - to sit in a room isolated doing something that is potentially quite painful and emotionally taxing.'

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