There isn’t enough general practice to go around

There isn’t enough general practice to go around

The British Red Cross charity rightly reports NHS hospitals and ambulance services are in a state of ‘humanitarian crisis’. At the same time, the chair of the Royal College of General Practitioners voiced concerns that urgent care – often of minor illness – threatens the care of patients with serious long-term conditions. ‘Something has to give’ she concluded.

Next we heard Theresa May blame GPs. She said the reason hospitals aren’t coping is because GPs aren’t open seven days a week and just aren’t working hard enough. This is demonstrably not true.

A few months ago we received a letter from Victoria Atkins MP asking what we were doing to reduce waiting times for routine appointments. We replied that our doctors and nurses couldn’t work any harder without risking patient safety. We pointed out that it was in her Government’s power to allocate more resources to primary care. Her response suggested we had evaded the question, and repeated the Department of Health line on investment in the NHS. Our second reply is posted here for you to read. Our second letter remains unanswered.

The GPs at Spilsby love our work; talking to people, helping them with their problems. We love that we get to know our patients so are best placed to understand their needs. We feel our patients’ joy when they get better from illness or overcome adversity, and that we help them do so. We also feel our patient’s pain when life kicks them. And we don’t take this for granted; we feel privileged to be in that position. Up until recently, General Practice had very high job satisfaction. But no longer, as evidenced by GPs leaving the profession in droves and fewer doctors wanting to take their place.

The alleged £10 billion investment in the NHS won’t even keep pace with inflation in the cost of healthcare. At the same time, local Sustainability & Transformation Plans demand £26 billion of savings. A saving where there is little saving to be made is a cut. We fund the NHS less than any comparable European country. We have less hospital beds than most; fewer doctors too. Germany has nearly three times as many hospital beds and twice as many doctors. France is similarly well resourced. Yet we expect more than any of those other countries. And the result is the current mess.

Details of cuts in GP services in Lincolnshire will be made public in the coming weeks. We will no longer be able to request MRI scans. Expect long waits to see a specialist first if we think you need a scan. Hip and knee surgery won’t be allowed by the CCG if you are overweight. (You may be overweight in part because you struggle to exercise because you need a hip or knee operation). GP referrals to certain specialities may be vetted, although such referral management schemes have never been shown to make cost savings. There’s more to follow. GPs who work for the CCGs were largely bypassed in this decision-making.

What new resources might exist appear tied to promises of seven day GP access. We explained our thoughts and fears about seven day opening in November 2015 (see below). No other country has their surgeries open 8-8pm seven days a week. They don’t need them to and couldn’t afford such a service. Neither can we. We already have a 24-hour GP service already for emergencies – Out of Hours.

There have been 18 pilots for seven days working in pilot sites (These were generously funded by the David Cameron’s ‘Prime Minister’s Challenge Scheme’. This isn’t what Mrs May is suggesting – she wants us to do more with the same funding or less). These pilots have mostly been unsuccessful and are considerably less cost-effective than the appointments we currently provide.

The idea is not that your local surgery opens seven days a week; simply a group of surgeries having a service on one site (in Lincolnshire likely to be many miles away from you) offering appointments for a whole area. The GPs would take it in turn at these weekend ‘hubs’. You can have a weekend appointment, but it’s unlikely to be with your own doctor and there will be less regular appointments at local surgery because we’d be doing shifts at the ‘hub’ instead. At Lincolnshire East CCG the plans are presently at the ‘how in god’s name are we going to commission that with the ongoing financial and staffing crisis’ stage.

Out of 35 studies European Countries studied by the Euro Health Consumer Index in 2015, the UK came 28th in terms of number of doctors per head of population.
A GP practice is funded only £136-157 per head of population for all that years care. Some people pay as much each year to insure their pet rabbit’s health!
The World’s most influential health think-tank, The Commonwealth Fund last year found that the UK’s GPs are the most stressed out of the 11 leading western nations.
GP appointment numbers have increased from 310 million in 2010 to 370 million last year. This means we spend less time with each individual patient than many other countries.
More than 20% of GPs suffered work related illness in 2015. 30% of GPs plan to leave the NHS in the next five years.
201 GP practices closed in the last year.
We fund our NHS to levels lower than virtually all first world countries and expect it to do more than those comparator countries. The government tells you not to believe the people on the frontline, the evidence and the experts. They tell you there is no lasting problem which can’t be solved by increasing efficiency and the staff working harder. Don’t believe them. General Practice is in real danger now of extinction, and with it the NHS as a provider of equal care to all free at the point of delivery. Please don’t let this happen. Please protect the care you value. You might consider writing to our MP as a start.