Tackling 'undoable' workload key to reversing GP workforce crisis

Retaining experienced GPs will remain a 'massive challenge' unless unmanageable workload is addressed and doctors are no longer expected to see 50-60 patients a day, the RCGP chair has said.

Panellists at RCGP 'Question Time' debate (Clockwise from top left: Professor Martin Marshall, Prerana Issar, Professor Becky Malby, Christiana Melam. Photos: Pete Hill/RCGPFA )

During a Question Time-style debate at the RCGP 'Fresh Approach' conference, Professor Martin Marshall welcomed rising numbers of doctors training to become GPs, but warned that the GP workforce crisis was 'fundamentally about workload'.

He told the online conference: 'We are getting great success with turning on the taps into the bath if you like, with the numbers of people wanting to come into general practice - the number of training places that are being delivered is brilliant. 

'But the plug is out of the bath because people of my generation are either retiring early or working part time and that is a massive loss of expertise.'

GP workforce

The college chair added that half of the graduate output of every medical school in the UK should be going into general practice - a significant rise from less than a third currently.

GPonline reported last year that a record 3,793 GP training posts were filled in 2020 - well above the target of 3,250 - and the government plans to increase available posts to 4,000 from 2021.

However, the fully-qualified GP workforce remains in decline - with a drop of 339 FTE GPs between December 2019 and December 2020 according to NHS Digital data.

The college chair pointed to a promise by former health secretary Jeremy Hunt to deliver 5,000 extra GPs by 2020/21. 'That was not delivered - we have now been promised 6,000 more GPs by 2024,' he said.

Flexible GP roles

Professor Marshall said: 'The workforce is a massive challenge for GP and has been for long period of time. By workforce I mean from my perspective particularly general practitioners but also the whole of the primary care workforce.

'We are doing everything we can to make general practice as attractive a job as possible - we are working with NHS England and others to create posts that look attractive, maybe four-session posts where they provide clinical care for three and mentorship and support for next-generation GPs for the fourth.

'There have to be ways of making the contractual state of general practice more attractive. Fundamentally this is about workload though - if workload remains undoable, and GPs are expected to see 50-60 patients a day and to be kind of compromising and taking risks on every single one of those we are not going to be making general practice an attractive career option. That is a real concern.

'We are continuing to put enormous pressure on the government to make the workforce larger and activity levels reduced.'

COVID-19 pandemic

NHS chief people officer Prerana Issar agreed the GP workforce was a 'big concern' and that workload was a key factor. She cited research showing that flexibility and an inclusive working environment were important drivers for retention of staff - and highlighted that 'how we find our way out of this pandemic in terms of the backlog of care' would also be a 'key pressure point for staff everywhere in the NHS.

Professor Becky Malby, a professor of health systems innovation at London's South Bank University, questioned the timing of the NHS reorganisation announced this week by the government, and raised concerns it could add to GP workload.

She warned: 'My worry is that with CCGs torn to pieces and ICSs sitting way above primary care networks (PCNs) how will PCNs get the support they need?' She said GPs were already affected by the work involved in running PCNs and reorganisation plans could create a further distraction.'

Christiana Melam, chief executive of the National Association of Link Workers - also taking part in the debate - agreed it would be a challenge for GPs not to be distracted.

Members of the panel agreed that the UK had a responsibility to invest in domestic supply of healthcare workers rather than relying heavily on recruitment from overseas. 

Professor Marshall said: 'We have a moral responsibility to be self sufficient. It means increasing the number of medical training places. We need more GP training places - and it should be 50% of every medical school's graduate output that goes into general practice. We are well short of that at the moment - it is currently around 27-30%.'

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