It’s been on this foundation of general practice, and the primary care we provide, that other NHS services have depended. We’ve managed demand, enabled efficient working elsewhere in the system, directed patients to the right specialist service, been innovative in care pathway design and above all managed clinical risk on behalf of the NHS as a whole.
But when the Ninth National GP Worklife Survey finds that nearly 40 per cent of GPs intend to quit direct patient care in the next five years, and more than 90 per cent of GPs are reporting considerable or high workload pressures, we know that the foundation of general practice has serious structural faults.
When the official workforce data shows that rather than gaining an additional 5,000 GPs we’ve lost over 1,000 full-time equivalent GPs, we know that the foundation is cracking.
When over 1,000 GPs have referred themselves to the new GP Health Service in England because of stress and mental health problems, or when hundreds of practices have closed and over a million patients have been forced to look for a new GP service, we know that the foundation is breaking down.
For far too long our service has been undervalued and taken for granted. GPs’ work ethic and dedication to their patients has been exploited through a decade of underfunding and soaring workload pressure, with the assumption that the GP practice will always be there to pick up the workload that others say they cannot or will not do.
The NHS fails to commission a specialist service, well don’t worry, the GP can do it; local authorities cut smoking cessation or weight management services, but don’t worry, just make an appointment with your GP and they’ll prescribe what you need; a new specialist care home or private hospital opens up in an area without any warning or planning, but don’t worry, the GP will pop around regularly to visit everyone; and then some bright spark comes up with a well-meaning idea that just requires the patient to get a letter from their doctor, but don’t worry because that’s what GPs are there to do, isn’t it?
Well let me make it clear, it is now time to worry. The foundation of general practice on which the NHS is built is seriously at risk of collapsing and if the NHS wants to survive in to old age we need urgent action now.
In our report Saving General Practice, we highlighted the need for real investment that provides an additional £3.4bn recurrently each year. We need to seriously step up our workforce plans to ensure every practice can recruit a GP when they need to and that existing GPs are properly supported.
We need to invest properly in premises and prevent bodies like NHS Property Services from pushing practices to the point of closure by their unacceptable and unjustified cost hikes.
We need a step change in IT support, enabling every practice to have the technology to offer smartphone consultations when appropriate. We need primary care support services that actually support practices and GPs, and don’t make our work harder and more difficult to deliver. And we also need to deal with the problem of indemnity.
Almost uniquely in the NHS, we have to effectively pay an indemnity tax of many thousands of pounds just for the privilege of working.
Despite the challenges and the pressures, the Government’s recent announcements show that we are winning the argument but there is much that still needs to be done.
We will not give up on our vital task to save general practice, to rebuild the solid foundation on which the NHS has been built for 70 years and work with the whole BMA to ensure our patients get the best possible healthcare for generations to come.
Dr Richard Vautrey is a Leeds GP and chairman of the BMA’s GP Committee. This is an edited version of his keynote speech to the organisation’s annual conference.