General practice is in crisis – a crisis that has until recently seemed largely invisible to national policy-makers.
While the pressures facing hospitals are obvious through almost real-time data on activity and performance, by contrast there is almost no nationally collected activity data – and certainly none available in real time – for general practice, or indeed for community and mental health services.
It’s unthinkable that information about activity in A&E would only be available through a retrospective research study, such as our report Understanding pressures in general practice published today, which examines data that is more than a year out of date – yet that is exactly the case for general practice. And while the scale of deficits in hospitals is also very visible, deficits in general practice do not show up on the NHS’s balance sheet; rather they are absorbed by GPs taking pay cuts and spreading staff more thinly.
Over the past nine months the King’s Fund has developed a detailed picture of the pressures in general practice and the causes of those pressures. We found that activity grew by more than 15% between 2010/11 and 2014/15 and this growth in activity has not been matched by growth in either workforce or investment.
And while activity has increased, so too has the complexity and intensity of the work. GPs are seeing increasing numbers of older people with multiple chronic conditions –contacts with those over 85 years old grew 28% whereas contacts with working age adults grew only 4%.
Managing complex patients in the community means GPs need to provide increasing numbers of new treatments and new preventive services. They are frustrated by increasingly complex and distanced relationships with secondary care services. Rising thresholds for accessing community and mental health services compounds the pressures on general practice, which is exacerbated by complicated commissioning and funding systems.
All this is taking its toll on staff and is having a direct impact on recruitment and retention of GPs and other members of the primary care team, including practice nurses and practice managers. According to the Commonwealth Fund, GPs in the United Kingdom are finding their job more stressful than their counterparts in other countries.
We surveyed trainees as part of our research and found that the key reason that only 11% of GP trainees intend to do full-time clinical work in general practice five years after qualification is the intensity of the working day. This is true for both male and female trainees.
The DH and NHS England have failed over a number of years to collect data that would have provided advance warning of the crisis now facing general practice. We hope that our report will help to shine a light on the pressures facing a service that needs to be at the heart of the NHS of the future.
- Beccy Baird is policy fellow at the King's Fund