Why manifesto promises of more GPs may not make general practice safer

Politicians of all stripes have promised more GPs during the general election campaign, but the extra doctors may not be enough to make current workload safe - let alone deliver extra appointments.

GP consultation (Photo: Robert Johns/UNP)
GP consultation (Photo: Robert Johns/UNP)

It's widely acknowledged that general practice has a severe workforce shortage, and with waiting times for appointments on the rise politicians have been vying to promise extra GPs and better access in the run-up to the UK's first December election in nearly a century.

The Conservatives have promised 6,000 more GPs and 50m more appointments. Labour has promised an extra 27m appointments - to be delivered with around 5,000 more full-time equivalent (FTE) GPs - while the Liberal Democrats have promised to 'end the GP shortage within five years'.

But analysis by GPonline suggests the existing GP workforce is delivering around 10% more appointments than the safe limit - and that given political leaders' promises of extra appointments with extra GPs, their plans for the workforce simply don't add up.

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Map: Which parts of England have the most patients per GP?
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How do NHS pledges from the main political parties compare?

NHS Digital data for September 2019 show that the current FTE, fully-qualified GP workforce is 28,315 - down 340 from a year earlier, and down more than 1,000 from September 2015, when former health secretary Jeremy Hunt made his ill-fated promise to deliver 5,000 more FTE GPs by 2020/21.

BMA guidance on safe working suggests that 115 appointments per week should be considered 'the quantified commissioned activity of an NHS GP'. A GP working 46 five-day weeks could, on that basis, deliver 5,290 appointments safely in a year.

But in the year to September 2019 there were almost 311m appointments in general practice - 53% of which were delivered by GPs. This means GPs delivered around 165m appointments - 5,814 for each of the FTE fully-qualified workforce, which is 10% more than the safe limit.

Another way of chopping up the data suggests that the shortfall could be even greater. Around half of appointments in general practice are with patients with multiple long-term conditions - and BMA guidance suggests that GPs can deliver only around 10 appointments at this level of complexity safely per day, while they can deliver around 25 'routine' appointments safely.

GP workload

If half of appointments are considered complex and half routine, general practice would need around 11.5m working days a year to deliver this safely - but based on the current FTE fully-qualified workforce, existing capacity is only around 6.5m.

Union leaders suggested earlier this week that general practice needed around 9,000 more FTE doctors - and this level of increase would take the profession well into safe territory based on the 115 appointments per week measure, although not on the 10 complex/25 routine calculation.

These calculations show that politicians - many of whose pledges involve a percentage increase in GP numbers in return for a similar percentage rise in appointments - are missing the basic fact that general practice needs more GPs simply to cope with existing demand. A GMC poll earlier this year showed that half of GPs feel unable to cope - and GPonline has reported previously that three GPs a day are seeking help from an NHS burnout service.

BMA GP committee chair Dr Richard Vautrey said: 'GPs are struggling to meet the increasing needs of their patients, many of whom are living with long-term, complex conditions. We desperately need more GPs to keep up with current demand and ensure patients get the care they need.

'While proposals to increase GP numbers are of course positive, politicians must be realistic about what this additional workforce can deliver, both in terms of addressing unsustainable workload for family doctors, and for patients who we know are often waiting too long to be seen.'

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