Viewpoint: The biggest threat to the future of the NHS

People have been asking me what I think will be the biggest threat to the NHS in the next five years. My answer is simple: workforce.

It is a crisis. I am glad it is now hitting the headlines although we must resist the temptation to think that fixing what is broken is either simple or quick. We simply do not have enough people in the NHS or social care and we do not have them in the right places.

There are issues everywhere you look. Let’s start with the bit I know best: GPs. So many things have come along that conspire together to encourage those already in the service to leave, including revalidation, changes to pensions, reducing incomes, increasingly busy days, and endlessly negative media coverage. All the while, fewer are joining us.

I recently attended a meeting where the problem of GP work stress was described as ‘decision density.’ As a GP you make so many decisions every day: in every consultation, every phone call, every visit, every pathology result. This is often done with limited clinical information. It is stressful. A GP’s work is much more decision dense than other areas of medicine.

I do not miss the intensity of GP work

I am no longer a practising GP and while I miss the patients I do not miss the intensity of work. As more nurses and other professionals enter general practice they do more of what used to be GP work and GPs spend a much higher percentage of their time doing the really tough stuff. It’s a good use of their skill base but it’s also very stressful.

Our CCG covers a very rural area, which has also become an issue now. Young doctors used to choose to work here, now most of them are settled before they leave medical school, so they mostly choose to stay close to where they trained - in cities. So suddenly we have fewer people on our GP training courses and fewer still choosing to work here afterwards.

At the same meeting, he heard that neither male nor female GPs want to be full time any more. So as older GPs retire, there are not people queuing up behind to take their places.

Nurses facing similar recruitment problems

And it turns out that there are not lots of trained but unemployed advanced nurse practitioners, paramedics or physician assistants out there waiting to help either - there are similar issues with nursing recruitment and retention. And having nurses in first contact roles gives them the same pressures and issues as GPs face.

This is just a snapshot of the issues facing primary care.These and other issues exist in hospital medicine, nursing and caring. Most importantly the NHS is not seen as a fun or exciting place to work. It is seen as hard, poorly funded work.

How do we change things? We need to openly and honestly accept the issues, and that they cannot be solved quickly, whatever the political rhetoric.

Central action required to lead change

It requires brave, central action to increase medical training places, and nursing places, and the safe gradual development of other models of caregiver with full evaluation of  impact. We need clarity about what the new roles are able to deliver and their limitations.

As a local economy, we need to think about the building blocks that will entice new  people to come to a rural area and those who grew up here to return, to make it an  exciting and vibrant place to live and work.

We need to make general practice medical and nursing roles, and community nursing roles, more attractive, and we need to fund it all properly so people receive fair pay for the job done.

This is a marathon not a quick sprint. We need to be able to tell the story of why it is great to work here in general practice… and believe it.

  • Dr Pleydell is GP and healthcare commissioning lead for Hambleton, Richmondshire and Whitby CCG

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