The GP workforce is in decline despite a record number of trainees taking up posts in the past two years. Over the 12 months to June 2019, the number of full-time equivalent (FTE) fully-qualified GPs in England slumped by nearly 600 - a drop of 2%. Against a backdrop of increasing workload this rapid erosion of the workforce is driving a crisis in primary care - so what have the parties promised to do for general practice and for the NHS as a whole?
Conservatives
On general practice:
The Conservative party has promised to recruit an extra 6,000 GPs, along with 6,000 other primary care workers such as physios and pharmacists on top of the 'army' of 20,000 staff primary care networks (PCNs) are meant to recruit by 2023/24 under the NHS long-term plan.
The party has also promised to increase the number of GP training posts from the current 3,500 to 4,000 from 2021/22, and has said its plans would create an extra 50m appointments in general practice by 2024/25.
Plans for 500 more GP training places, while welcome, fall short of an RCGP warning that the NHS needs to train 5,000 GPs a year to make general practice sustainable. Meanwhile, the party has not made clear whether the increase in the overall workforce it is promising refers to FTE GP numbers - and a previous promise to deliver 5,000 more GPs by 2020/21 failed to materialise.
On wider health and care policy:
Under the NHS long-term plan the Conservative party is committed to a £20bn real-terms increase in NHS funding over the five years to 2023/24 - including an increase in funding worth at least £4.5bn for primary and community care. The party's 2019 manifesto promises '£34bn per year by the end of the parliament in additional funding for the NHS' - this is the same figure as the previous £20bn promise, but in cash terms rather than real terms.
Conservative leader Boris Johnson promised in his first speech as prime minister to 'fix the crisis in social care once and for all'. Sweeping cuts to local authority funding in recent years have hit social care services hard, with GPs warning the cuts - alongside reductions in public health spending - have added to pressure on primary care. The Conservative manifesto promises that a £1bn increase in social care funding announced earlier this year, set to kick in from April 2020, will be maintained through the next parliament.
The Conservatives have been criticised over claims that the party is building '40 new hospitals' - a claim repeated in the party manifesto. The government admitted in September that in fact it was investing £2.7bn to build new facilities at six existing hospital trusts by 2025, with a further 21 receiving a share of £100m in 'seed funding' to develop business cases for investment.
The party is also promising 50,000 more nurses, but the manifesto does not make clear whether this is an FTE figure, or when this extra workforce will be in place.
Labour
On general practice:
Plans set out by the Labour party would increase GP training places to 5,000 per year, with a view to expanding the GP workforce and delivering an extra 27m GP appointments a year. Analysis of the methodology behind Labour's pledge suggests that it is aiming for an increase of 5,000 FTE, fully qualified GPs - an increase that outstrips promises from the other parties because this figure does not include trainees.
The party has not set a specific date by which the extra appointments would be delivered, but has said this would happen 'as soon as possible' - once the additional trainees progress into the workforce and create the extra capacity required.
Its 27m-appointment pledge relates specifically to appointments delivered by GPs, and is comparable to the Conservatives' promise of 50m more appointments in general practice as a whole - a figure which includes appointments by nurses and other staff.
The party's pledge to deliver 27m more GP appointments - a 17.7% increase from the 153m delivered between August 2018 and July 2019 - is based on its expectation that training more GPs can deliver a 17.7% increase in the number of FTE fully qualified GPs. In June 2019 there were 28,257 FTE fully qualified GPs - a 17.7% increase would mean 5,001 more.
The greatest caveat over Labour's pledge is perhaps the lack of detail on timescales. Given it takes three years to train a GP and currently trainees are not coming through fast enough to replace GPs leaving the workforce, a 5,000-FTE rise in fully qualified GPs looks a very tall order within the next parliament. Having said that, all parties will hope to do better on retention.
On wider health and care policy:
Labour has also promised a total increase in NHS funding worth £26bn in real terms by 2023/24, including £2.5bn for GP premises improvements. The extra funding would also pay for a £2bn mental health infrastructure fund, £1.5bn to boost MRI and CT scanning capacity, and £1bn to restore the training bursary for nurses and improve CPD.
Labour has also promised to make the NHS carbon neutral by planting an 'NHS forest' of 1m trees, to create an NHS working environment 'that is safe, flexible and free from harassment, bullying or violence', to scrap prescription charges and boost public health funding.
The party is also promising a 'lifetime cap' on personal contributions towards care costs - promising to ensure that 'no one ever again needs to face catastrophic care costs of more than £100,000 for the care they need in old age'.
Liberal Democrats
On general practice:
The Liberal Democrats have pledged to 'end the GP shortage in five years'. The party is promising a 'national recruitment strategy to match training places to future needs and tackle shortages of GPs and other NHS staff'.
An extra 1p on income tax will deliver £3.9bn for 'measures to tackle NHS understaffing, including in the GP workforce', the Liberal Democrats have said. The party has matched Labour's promise to expand GP training places to 5,000 - and says this increase will be delivered by the end of the parliament.
The party - which has built its general election message around stopping Brexit - says retaining freedom of movement through preventing the UK from leaving the EU will help 'support our current European GP workforce (4%) and attract GPs from the EU through a funded EU recruitment campaign' and has stressed plans to maintain mutual recognition of qualifications.
One criticism of the Liberal Democrat policy on the GP workforce could be that the party has not defined how it is measuring the GP shortage - or how many new doctors it would need to deliver to fill the gap.
The Liberal Democrats have also promised to 'make greater appropriate use of nurses, physiotherapists and pharmacists, and other health professionals to mitigate and bridge the gap between supply and demand in primary care' - in line with other parties' plans for more multidisciplinary care.
The party has promised to expand phone and video consultations 'where clinically suitable' and to improve staff retention in primary care 'through continuing professional development, better support, more flexible working and careers and improved mental health support for and training of NHS staff'.
On wider health and care policy:
The Liberal Democrats have also promised investment to tackle the 'social care crisis' - promising that part of the £7bn it expects to raise from its 1p income tax rise will go towards this sector.
The party is also promising a £10bn capital fund for healthcare services, to pay for equipment and improvements to buildings in hospitals, community, ambulance and mental health services.
In the longer-term, the Liberal Democrats plan to bring in a 'dedicated, progressive health and care tax' to fund a collective budget for a joined-up health and social care system, with an independent Office for Budget Responsibility-type organisation to report every three years on 'how much money the system needs to deliver safe and sustainable treatment and care'.
The party wants to create seamless health and social care, and to cap the cost of care.
