Government must act on GP crisis

The Commons Health and Social Care Committee said this week that the profession was demoralised with GPs leaving almost as fast as they could be recruited. And patients were increasingly dissatisfied with the level of access they receive. ‘The root cause of this is straightforward: there are not enough GPs to meet the ever-increasing demands on the service, coupled with increasing complexity of cases from an ageing population,’ the committee said in its report, The future of general practice.

The majority of GPs have not had individual lists of patients since 2004. And recent pressures mean it is even less likely people will see the same doctor regularly. Committee member Rachael Maskell (pictured) described this as ‘unacceptable’ and the trade-off between access and continuity had shifted too far.

‘Our inquiry has heard time and again the benefits of continuity of care to a patient, with evidence linking it to reduced mortality and emergency admissions,’ she said. ‘Yet that important relationship between a GP and their patients is in decline.’ The committee set out a number of recommendations to stop this decline and to address the wider crisis in general practice.

The creation of primary care networks was welcome but the new developments were not yet making a meaningful impact on the future sustainability of general practice. Instead the government and NHS should be bolder. The committee called for the quality and outcomes framework and impact and investment framework to be abolished. They criticised the frameworks as ‘tools of micromanagement’ that risked turning patients into numbers. The current system of incentives did not encourage GPs to deliver high levels of continuity and did not fund GPs for the additional work needed to manage more care in the community and reduce hospital admissions.

And the new two-week wait target for GP appointments, while well-intentioned, did not address the fundamental capacity problem causing poor GP access.

The committee called on the government to investigate the possibility of limiting list sizes to 2,500 and then reducing this to 1,850 over five years as more GPs are recruited. The government remains off track to meet its target to recruit 6,000 additional GPs by 2024, although the committee said it was encouraged by the growth in the number of GP trainees over recent years.

The committee was also concerned about inequality across the country, with the parts of the country facing more acute workforce shortages also having higher levels of ill-health and deprivation. The committee said the current Carr-Hill formula, at the heart of general practice allocations, was insufficiently weighted for deprivation and a better mechanism was needed to award funding to more deprived areas. (There are some areas that have already introduced a greater link between GP funding and deprivation  -- see Levelling up, Healthcare Finance December 2021).

Nuffield Trust senior fellow Dr Rebecca Rosen said the ‘yawning gap’ between patient demand and the number of GPs available had been allowed to grow for too long. ‘Targets and measurements do not create more doctors, and the fundamental problem is a mismatch between supply and demand,’ she said. ‘Rather than focusing on dictating how and when patients are seen, the government should realise that success depends on whether it can do enough to keep GPs in post and bring new doctors into the NHS.’

She said the committee was right to describe general practice as being in crisis. ‘The ball is now in the government’s court to respond with more than arbitrary targets and promises of staff they are not on course to deliver.’

Also this week, the General Medical Council called for the creation of a specialist and associate specialist (SAS) grade in primary care, as well as the expansion of primary care career options for physician associates. SAS and locally employed doctors have several years of postgraduate training, but have not gone on to become hospital consultants or GPs. Under existing rules, the group, which is set to become the largest on the medical register by 2030, is not able to work in general practice. The GMC believes more should be done to support and encourage this group to pursue longer careers in the NHS. Although the number of doctors in GP training is increasing, ‘expanding those able to work in the service should be part of the solution,’ the GMC said in The workforce report 2022.