Soaring pressure has left general practice at risk of collapse, King's Fund warns

Face-to-face consultations in general practice rose three times faster than the GP workforce over the five years to 2014/15, according to research by the King's Fund that offers fresh insight into the scale of the crisis facing the profession.

A report published on Thursday by the think-tank highlights the growing complexity and intensity of GP workload, with growth in patients aged over 85 far outstripping modest increases in the GP workforce.

Rising patient expectations and transfer of work from hospitals into the community have added to soaring pressure on GPs at a time when the proportion of NHS funding spent on the profession has slumped to below 8% - its lowest share in a decade - King's Fund researchers found. By 2014/15, GP income had fallen to its lowest level in real terms since 2002/3, they reported.

A 'consistent failure' by the DH and NHS England to collect national-level data that could have flagged up the crisis before it emerged have left the profession 'at risk of falling apart', the report warns. Since 2008, it says, there has been 'no systematic national data collection that can tell us about the number or nature of consultations, and who undertakes them'.

'The current situation is untenable if general practice is to remain at the heart of healthcare in England,' the report warns.

GP workload

In Understanding pressures in general practice, researchers present findings based on data from 30m patient contacts across 177 practices in England to reveal rising pressure on GPs between 2010/11 and 2014/15.

Face-to-face consultations in general practice increased 12.2% over the period, and the average number of face-to-face consultations per patient with a GP rose from 3.2 in 2010/11 to 3.7 in 2014/15. Telephone consultations with GPs soared by 69% over the five years.

Meanwhile, the complexity of GP workload was increasing - the number of consultations for patients aged over 85 with clinical staff at the practices increased by 28%. The report warns: 'People are living longer, with a consequent rise in the number of those living with chronic disease. This, combined with a policy focus on keeping care as close to home as possible, has meant that the key role of general practice is managing people with chronic and often multiple conditions.'

Pressure on GPs has also increased from 'complex new medicines' that require greater monitoring of patients, while the volume of non-clinical work practices face has risen and cuts to services such as community nursing have added to GP workload.

Read more: report author Beccy Baird on the GP crisis

Understanding pressures in general practice also highlights the chronic workforce shortage facing general practice, and warns that it is 'questionable' whether the government's 5,000-GP recruitment target can be met by 2020 'given current issues with both recruitment and retention of GPs'.

The report warns that although full-time equivalent GP numbers rose slightly faster than the general population between 2010 and 2014, the number of people aged over 85 grew 19% faster than the GP workforce. It warns that numbers of GPs leaving the profession aged between 55 and 64 almost doubled between 2005 and 2014, and the trend towards part-time working among the remaining workforce is set to continue.

The report calls for immediate steps including cuts to bureaucracy practices face from CQC checks, practical support to improve services and adopt new technology, and help to develop the wider primary care workforce. In the longer term, it calls for better data to prevent future crises developing unchecked, and moves towards new models of care with more working at scale, and plans for sustainable GP careers.

Lead author of the report, King's Fund fellow Beccy Baird, told GPonline that it was 'hard to see how national NHS policy makers can be sure they are making the right decisions for the future of general practice' given the lack of clear workforce and workload data. Sustainability and transformation plans being developed to shape services across 44 regions in England 'must take general practice seriously', she warned.

General practice capacity

GPC chairman Dr Chaand Nagpaul said: 'This well-researched report provides further tangible evidence of the scale of the increase in GP workload which has totally outstripped GP services’ capacity to deliver effective patient care.

'While patient demand has increased, successive governments have failed to provide GP practices with the resources or staff to ensure the public gets the care it needs. More than 300 GP practices told a recent BMA survey they were facing closure and around the country there is an ongoing shortage of GPs that has left many patients struggling to get appointments.

'We need the government to implement an immediate rescue plan to protect and secure the future of the family doctor service across England.'

RCGP chairwoman Dr Maureen Baker said: 'This report provides cold hard facts that confirm what the college has been saying for years – that general practice is suffering under the unsustainable pressures of rising demand and a diminishing workforce.

'GPs and our teams are making more consultations than ever before, and our patients are living longer and with multiple, long-term conditions, meaning that our workload is growing in complexity as well as volume, making the standard 10-minute appointment increasingly unfit for purpose.

'NHS England’s recent GP Forward View provided long overdue recognition of the essential role GPs and our teams play in keeping the NHS sustainable and safe for patients. But it was also an acknowledgement of the devastating impact of a decade of chronic underfunding for general practice. It is vital that the pledges of increased funding and support for general practice set out in the GP Forward View are put in place as quickly as possible.'

A DH spokeswoman said: 'With an ageing population, we know GPs are seeing more patients with complex health conditions than ever before. That is why we are taking action to double the growth rate in GPs through new incentives for training, recruitment, retention and return to practice.

'NHS England's GP Forward View, which commits an extra £2.4bn for general practice by 2020/21, will help to reduce the pressure on GPs and retain a healthy workforce well into the future.'

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