GP services funding higher in 1950s

Statistics report shows record NHS cash increases, but GPs' share remains constant. Nick Bostock reports

UK spending on GP contracts almost doubled over the last decade to around £135 per capita in 2004/5, according to an annual overview of NHS costs.

But the increase was only marginally ahead of total NHS spending, which rose 88 per cent to around £104 billion over the same period, bringing UK healthcare spending as a proportion of GDP close to EU levels.

The rise means that in 2005, GP services accounted for an estimated 9 per cent of NHS spending, only 1 per cent higher than its share of the budget
in 1949, the first year after the NHS began.

The share of NHS cash consumed by GP contracts peaked in 1952, at around 15 per cent.

Overall, the figures from the Office of Health Economics’ annual Compendium of Health Statistics show that Scotland spends the most on the NHS per capita. It spent £1,579 in 2004/5, compared to £1,473 in Northern Ireland, £1,457 in Wales and £1,389 in England.

GP demographics
The report also reveals that the total number of GPs contracted to the NHS UK-wide grew to 42,735 in 2005. This figure was up nearly 20 per cent from 1995.

Women now make up 42 per cent of the GP workforce, which is double the proportion they accounted for in 1985.

The average age of GPs has also increased over this period. Only 31 per cent of GPs were less than 40 years old in 2005, compared to 40 per cent in 1985.

Significant changes in the working practices of GPs are highlighted in the report.

The proportion of GPs in partnerships of five or more in 2005 rose to 58 per cent, compared to 43 per cent a decade earlier and 19 per cent 20 years ago in 1975.

The shift towards larger practices has occurred throughout the UK and as a result, the proportion of single-handed GPs fell from 10 per cent in 1995 to
5 per cent in 2005.

Figures for consultation rates, along with the rise in total GP numbers, appear to reflect the recent growing trend towards part-time working.

The total number of GP consultations in the UK was 268 million in 2004, and changed little over the previous decade.

However, the number of consultations per GP dropped sharply, from 8,016 in 1994 to 6,983 in 2004.

Consultation costs
The report shows that UK patients visit their GP four times a year on average.

The total annual per capita cost of these consultations in 2004 was £104, a real terms increase of around 50 per cent from 1994.

Average list size per GP in the UK has fallen by almost 14 per cent in the last decade, but this was not uniform across the UK.

While the average list size fell from 1,835 to 1,613 in England, and from 1,506 to 1,331 in Scotland, the decreases were much less significant in Wales and Northern Ireland.

In both of these countries the lists fell from roughly 1,710 to around 1,650.

The list sizes per GP are reflected in the number of GPs per capita in each country.

Scotland had 80 GPs per 100,000 of population in 2005, compared to 63 in Northern Ireland and 65 in both England and Wales.

Longer consultations
GPC member Dr Nigel Watson said consultations per GP had fallen because of part-time working, and changes in consultation lengths.

‘Ten years ago GPs were doing six-minute consultations, now it’s moved to ten minutes. Consultations are longer and a lot more complex.’

Dr Watson said that in the past most partners were full-time, but now many practices had up to half of their partners working part-time.

He said that GPs worked far harder now than in the past.

‘There is more work crammed into the day now. We used to go home for lunch, but now lunch is for doing paperwork. Consultation figures do not show the full picture of workload.’

GPC Wales member Dr Ian Millington said the ageing GP workforce was a particular issue in Wales. ‘There is a demographic time bomb, with a large number of over-55s.’

He said the fact that per capita NHS spending in Wales was lower than both Scotland and Northern Ireland was disappointing given high disease prevalence in the country.

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