Two in five GPs to quit inside five years as Forward View flounders, warns RCGP

General practice is near breaking point with two in five GPs in England planning to leave the profession within five years, according to an RCGP report that demands faster implementation of the GP Forward View.

RCGP chair Professor Helen-Stokes Lampard (Photo: Pete Hill)

One in 20 GPs responding to polling by the college reported feeling so stressed they couldn't cope every day of the week, while 40% felt this way at least once or twice a week.

The college's assessment of the first year of the GP Forward View - which promised to increase annual investment in general practice by £2.4bn by 2020/21 - found that there have been 'very significant steps' in support of the profession since the programme was launched in April 2016.

Significant new funding delivered to general practice in 2016/17 suggests the 2020/21 funding pledge - which the RCGP calculates will take GPs' share of overall NHS funding beyond 10% - is on track, the college reports.

GP workforce target

But it highlights huge problems facing the profession and warns that Forward View funding has been too slow or simply not materialised in some areas. The college calls for a rethink on the government's flagship pledge to deliver 5,000 extra GPs by 2020, while the GPC urged ministers to admit the target is no longer achievable.

Half of GPs polled by the college in February this year believed it was unlikely the GP Forward View would make a positive difference to general practice in England, up from 39% in August 2016 - suggesting that faith in the process is being eroded rapidly.

Workforce is the 'most troubling area of implementation' of the GP Forward View, the college warns, pointing out that 'if anything there are fewer' GPs working in the profession than before the programme began. Data released last year showed that the number of full-time equivalent GPs in England fell 445 in the three months to December 2016.

One GP in south-west England responding to RCGP polling said that despite advertising for 18 months through the college itself and a medical journal, and a 'huge drive with videos and adverts for six months' by the CCG, not a single applicant came forward for a GP role.

GP recruitment

A total of 71% of GPs involved in recruiting said attracting other GPs had been difficult in the past year, and more than a third said there had been at least one vacancy at their practice for more than three months.

In addition to a positive assessment of overall funding coming into the profession rising, the college welcomed schemes to boost non-medical professionals such as pharmacists, nurses, physios and mental healthcare staff working in and supporting general practice. It welcomed a recent recruitment drive that will aim to bring 2,000 GPs from overseas to England by 2020.

The college's polling also found that although most practices had taken steps to tackle workload in line with the 'high impact actions' outlined by NHS England, many could do more work on improving the 'personal productivity' of GPs and other staff. The report highlighted suggestions from NHS England that GP practices could release 10% of their time through 'productive general practice' support on offer - although the college called for more testing of the measures to prove they 'genuinely make a difference'.

RCGP chair Professor Helen Stokes-Lampard said: 'It takes at least three years in specialty training for new doctors to enter the workforce as independent consultant GPs so while it’s fantastic that more foundation doctors are choosing general practice this year, if more people are leaving the profession than entering it, we’re fighting a losing battle.

Workload pressures

'Above all else we need to see efforts stepped up to keep hard working, experienced GPs in the profession, and the best way to do this is to tackle workload pressures and improve the conditions under which all GPs and our teams are working.

'The college stands by the GP Forward View – we continue to think that it is the lifeline general practice needs to get our profession where it needs to be. But things are moving too slowly. Our endorsement of the original report means we can hold NHS England, Health Education England, and other bodies to account, and that’s what we’re doing with today’s report.'

GPC chair Dr Richard Vautrey said: 'Despite the GP workforce shrinking again last year, the government has continued to promise 5,000 extra GPs to patients. It is time to admit that this pledge is now unachievable.

'General practice is facing unprecedented pressures from rising patient demand, tighter budgets and widespread staff shortages. Many GP practices are struggling to meet rising demand on services, with a recent BMA survey finding that eight out of ten GPs believe their workload is either unmanageable or excessive.

'While the GP Forward View's focus on extra staff and investment in general practice is correct, it fails to provide sustainable or recurrent funding, and the delivery so far has been inconsistent with little tangible improvement to the delivery of local services to patients.

'In order to create a stable GP workforce, the government must expand the number of GPs entering the profession, and urgently address the underlying issues, particularly the unsafe workload pressure, behind the recruitment and retention crisis in general practice.'

An NHS England spokesman said: 'This report rightly acknowledges the hundreds of millions of pounds of extra investment we are putting into general practice and the big difference it will make to both GPs and patients. We are just over one year into a five-year action plan and, as the RCGP point out, it will take time for all the effects to be felt but the measures we are working on, including expanded recruitment schemes, show how committed we are to helping GPs meet the needs of ever-rising patient demand.'

A DH spokeswoman said: 'We recruited the highest number of GP trainees ever in 2016, but crucially, we are giving GPs the financial backing to support improvements in patient care, with a £2.4bn increase in funding.'

Writing for GPonline in June, health secretary Jeremy Hunt highlighted plans to boost GP recruitment, investment through the GP contract, plans to tackle burnout and bring in new models of care - stressing the profession's essential role in the NHS. He said changes to create sustainable general practice would 'not happen overnight', but argued that 'we are beginning to turn a corner'. 

Key recommendations:

  • NHS England to review with stakeholders what more can be done to reduce GP workload to a manageable level
  • CQC should conduct and publish an impact assessment of proposed changes to GP inspections
  • CQC should use the opportunity of changes to the regulatory inspection regime to consider the reduction of fees
  • NHS England and NHS Improvement should raise awareness of the changes to the NHS standard contract among trusts and hold commissioners to account to ensure the new contract terms are enforced
  • NHS England should continue to develop collaborative care and support planning for people living with multiple long-term conditions
  • NHS England should continue to work with other organisations and the profession to develop a successor to QOF, with reduction in administrative burden made a key test
  • NHS England should form a working group to investigate and clarify mandatory training requirements
  • Work should begin with payment providers to streamline payment processes for practices to focus on improvements to consistency and accuracy of payments

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