GP crisis: Ministers must listen to NHS staff and tackle the workforce crisis

Anyone at the coalface in the NHS can confirm the health service is facing a workforce crisis, says BMA deputy chairman Dr Kailash Chand. Warning signs that the service - once the envy of the world - is in crisis are growing, and the government must act to save it before it's too late.

I don’t know how much of numerous trusts' money and time it took for the BBC investigation published today to find out precisely what anyone working at the coalface in the NHS could have told them - there is indeed a shortage of medics and nurses in almost all the crafts of the NHS.

Skills shortages in areas such as A&E, general practice and critical nursing are well documented and quickly spreading to other staffing groups. Understaffed hospital departments could put patient safety at risk. Reports have suggested that many hospitals in England are missing targets for nurse staffing levels, and in emergency medicine and paediatrics there are hundreds of vacancies.

The problems facing GP practices are all around us. There are now 7,962 GP practices in England – one in 20 has disappeared since 2010. One in eight GP practices have merged with another practice in the past 12 months or plan to do so in the coming year, a recent GPonline poll revealed.

GP workload

GPs’ ever increasing workloads – not helped by the denigration of the profession by media and politicians – is bringing about a recruitment and retention timebomb. Trainee numbers are dwindling and GPs are moving abroad in their droves. We now have a dangerous situation where there are hundreds of vacancies for GP trainees. Meanwhile, one in three GPs tell the BMA they are considering retiring early and practices report they are struggling to meet demand for appointments.

The morale of the NHS family in general and general practice in particular is at rock bottom. Their pay has been frozen for several years, the recent uplift in primary care in expenses is peanuts, and they have been forced to accept a major downgrading of their pension benefits. Freezing and squeezing pay is heaping financial misery on the entire NHS family. The ongoing, demoralising influence of the regulator, the CQC, only makes matters worse.

The rising workload, falling funding, salary freezes - means that some doctors are opting for early retirement while newer medical graduates are moving abroad or less inclined to go to deprived/rural areas or challenging specialities. Rather than addressing the huge challenges of recruitment and retention, attempts are being made to encourage the private sector in healthcare. And private sector providers want to de-professionalise and down-skill the medical profession to make staff more interchangeable, easier to fire, more biddable and, above all, cheaper.

Ageing population

The NHS faces a growing challenge in the coming decades - the number of over 65s is expected to rise by 50% in the next 20 years, and by 2030 one in three Britons are projected to be obese. Advances in healthcare mean people are living longer and survival rates for diseases such as cancer are improving.

But this means more people are living with long-term conditions such as diabetes, and have complex medical needs. For the NHS to cope, we need to find a sustainable way of dealing with this unprecedented rise in demand. The staff shortage could drive healthcare to third-world standards in a country where the NHS once was the envy of the world and general practice the jewel in its crown.

The number of doctors, both GPs and consultants, who are considering retiring early is staggeringly high and a huge worry for the NHS and patient care. The health service could be left with a shortage of clinicians, with the remaining doctors spread too thinly. This has huge implications for recruitment and retention for the medical profession. If this administration doesn’t look after the genuine concerns of its workforce, the very future of the NHS is at risk.

The NHS has never been in a more dangerous position than it is right now. The prime minister needs to forget about political gimmicks and focus on addressing the pressures facing the NHS. He needs to get real about how we properly resource and rebuild the publicly funded NHS.

  • BMA deputy chairman Dr Kailash Chand was writing in a personal capacity

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