North-east London STP clinical director and GP Sir Sam Everington revealed the shocking prediction to the House of Lords committee on NHS sustainability.
‘We have estimated within our STP that we are going to have half the number of GPs in five years' time,’ he said. ‘That's not something we choose to do. That's the reality of our analysis of how many GPs there will be around.’
Sir Sam told peers that medical schools should be incentivised to meet GP training targets, while health education budgets should be made accountable to STPs.
The draft STP for the area published this week revealed plans to overcome the workforce crisis with greater use of physician associates and other primary care staff.
Tower Hamlets LMC chair and GPC member Dr Jackie Applebee said the predicted loss of GPs in the area was ‘eye watering’ and ‘horrific’, but plans to plug that gap with physician associates would mean ‘a real deterioration in quality of care’.
GPonline revealed earlier this year that plans for part of north-east London, which fed into the overall STP for the area, envisioned the GP workforce being reduced by a third over the next decade.
The draft STP, covering eight boroughs in the east and north east of Greater London, is planning for an even more dramatic collapse in numbers.
Dr Applebee accused health bosses of working on the assumption that the government’s pledge to recruit 5,000 new GPs would not happen. ‘They need to do more to make it happen,' she said.
The LMC chair said she was concerned NHS leaders could use forecasts of falling GP numbers as a ‘smokescreen’ for cost savings.
‘They can wring their hands and say: "There is nothing we can do about this, GP numbers are going down". And they are right, they are going down. But rather than being proactive, and trying to increase recruitment into general practice, I think it's being used as a smokescreen so that they can cut costs. Not that they welcome it, at all. But because it is happening, they can say, "natural wastage".'
The reliance on physician associates, who could be given prescribing powers, was a ‘downgrading’ of GP services for patients, said Dr Applebee. GPs will not have time to supervise them, and ‘diagnoses could be missed’, she warned.
The Somerset STP published last week revealed plans for an 18% reduction in GPs in the county, with gaps filled by paramedics, healthcare assistants and other clinicians.
The north-east London system faces a projected £578m funding gap by 2021 unless changes are made. The plans include ambitions for accountable care systems across the 'footprint' STP area, building on existing new care models vanguards and devolution pilots.
The STP calls for ‘the radical transformation of primary care’ to lead the development of a successful out-of-hospital system.
Enhanced primary care
But the area, which contains high rates of deprivation, faces population growth of 18% over five years and a GP workforce crisis. In one borough, more than a quarter of GPs are beyond retirement age.
Under plans for enhanced primary care, GPs will focus on co-ordinating care for those with complex and long-term conditions while other clinicians take a greater role for those with minor illnesses.
Joint care planning will enable ‘seamless delegation’ to the extended primary care team and collaboration with social care, it says.
The STP calls for resources identified in the GP Forward View for managing workload and care redesign to be delegated to the STP to be managed overseen by a new governance arrangement including GP federations, RCGP and LMCs.
The plans also include the downgrading of an A&E department to an urgent care centre.
Dr Applebee said while the ambition for greater integration of services around patients was they kind of care clinicians wanted to provide, the STP was ‘completely unrealistic’ given the financial state of the local health system.
‘It raises expectations,' she said. ‘And somebody needs to call this what it is. It is the Emperor's New Clothes. I don't think people should collude with this. They should shout from the rooftops that this is a slashing of our NHS, forcing us into cheaper models and ultimately making it more attractive to the private sector.’