Richard Vautrey: Why we must heal the crisis in GP care

AS record numbers of GP surgeries close, the Government must begin to grasp the real extent of the impact that the crisis in general practice is having upon patients and their communities as general practice reaches breaking point.

GP surgeries are at breaking point, warn the BMA.
GP surgeries are at breaking point, warn the BMA.

An investigation by Pulse found that there had been a 150 per cent increase in the number of practices closing
since 2014. Indeed, in Yorkshire,
closures of practices in areas including Sheffield, Leeds, Hull and Rotherham, and mergers in practices in York and Grimsby, have displaced thousands of patients.

Some have had to shut their doors entirely while others have merged into larger practices. Whilst bigger practices may be more economically viable, the merging together of local practices has the potential to break the vital link between GP and local community, and could disadvantage more vulnerable patients who may find it difficult to travel further afield.

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Perhaps more importantly, my experience working as GP in Leeds for over 20 years has taught me how invaluable it is for patients to build relationships with their doctor and how its impact extends far beyond the nominal tasks of providing prescriptions.

The continuity of care offered by local practices is the bedrock of the wider NHS, and one of the key reasons it remains so effective, despite all the current pressures.

The closure of GP surgeries is the result of the recruitment and retention crisis coming into full effect as surgeries struggle with not being able to attract
and retain staff. Not enough young doctors or nurses are choosing a career in general practice, making it increasingly difficult to find new staff when others retire.

Despite the best efforts of hardworking doctors, nurses and practice staff, they are struggling to offer a safe level of patient care working with the current pressures. As more of us live longer, we often need to see the GP more often. In addition, work that was once done in hospitals such as the management of diabetes, asthma and hypertension, is now largely done in general practice. This increased frequency and complexity of consultations cannot be delivered without an expansion of the workforce, and yet in places the opposite seems to be happening. 

Indeed, a recent survey from the BMA showed that more than 300 GP practices were facing closure while many more are considering closing their practice lists because they cannot safely treat the sheer number of patients coming through their surgery doors.

A further survey from the BMA revealed that a third of GPs were considering retiring earlier than normal and one 10 admitted to leaving the country to find work elsewhere. This doesn’t exactly go hand in hand with the Government’s promise to recruit 5,000 GPs by 2020.

Doctors want to do the best they can for their patients. They know what could be achieved with the right support but they feel that their patients are being let down.

The crisis in general practice is symptomatic of problems throughout the rest of the National Health Service which is underpinned by a chronic lack of investment across the board; in hospitals, social care and mental health. They are all inter connected and if one service is struggling, the ripple effect will very soon become evident.

North Yorkshire CCG’s decision to ration access to operations for obese patients and smokers was a direct result of this significant financial pressure, not just in that area but right across the region. It should sound a warning bell for all of us. No doubt general practice will also receive cuts to funding in this area as the financial pressure impacts the service as a whole.

And there is further cause for
concern as, in the aftermath of Brexit, the future of the Health Service looks increasingly uncertain. A recent survey carried out by the BMA of doctors from the EEA found that more than four in 10 were considering leaving the UK following the Brexit vote. Unsurprisingly, doctors felt that they were substantially less appreciated by the UK government but still felt appreciated by patients.

It is sad to say, but it seems that our NHS is regressing instead of progressing. Family doctors are a vital cornerstone of care in the community. If general practice fails, the NHS will fail. We cannot allow that to happen.

Dr Richard Vautrey is a GP in Leeds and deputy chair of the British Medical Association’s GP committee.