What is happening on the ground is, that proportion of patients waiting to see their GP within a week has been creeping up, safety and quality could be the next casualty.
In mid-2011 it was 13%, though rose to 14% by the end of 2013, then reached 15% in mid-2013 and then 16% in July, according to the GP patient surveys. Patients are bearing the brunt because there are too few GPs to meet the rising demand for their services and those in post are overworked and overstretched as a result.
The root cause of the crisis is this unprecedented combination of rising patient demand and declining resources. The government is also asking GP practices to provide more services, including many involving the transfer of hospital care into the community, without the resources required to successfully deliver them.
Average number of consultations undertaken by each GP has risen
Practice incomes have been frozen for several years and this has led to real net incomes dropping by more than 20% since the introduction of the GP contract in 2004. Practices are being brought to their knees by this unprecedented fall in money for primary care and rising demand for GP services. The funding in primary care in England has gone down from 11% in 2005/6 to a record low of 8.39% in 2012/13, despite GP surgeries treating about 40 million more patients a year than five years ago. The average number of consultations undertaken by each GP has also risen over that period, from 9,000 to nearly 11,000.
GPs’ workload and denigration of profession by certain section of media and politicians is bringing a recruitment and retention crisis timebomb. Trainee numbers are dwindling and young GPs in droves are going abroad. GP practices are heading for the rocks as workload rises, morale drops and the government continues to ignore the problems stacking up in this crucial part of the NHS.
GPs are doing their best to cope with this. They are working harder than ever before, getting through 340m consultations each year. They are also changing the way they work to give patients want they want – more emergency care and weeknight appointments.
But there is a limit to what GPs can do when patient demand is going up and resources are going down. With an ageing population that needs more complicated care and longer appointments this is only going to get worse.
To avert a crisis in general practice,Jeremy Hunt needs to take steps to increase funding in the same way as £500m was found last year to avert the A&E crisis. Without this, the reality is that patient care – and the very future of the NHS – is at risk.