What can help our GPs cope?
Edmund Stubbs, 9 April 2015
The fact that only eight per cent of GPs think that the currently allocated 10 minute patient consultation slot is long enough is startling. When less than one in ten of a profession thinks working guidelines are reasonable then it is certainly time for a change.
Today the BMA released a survey entitled the ‘Future of General Practice’. As well as containing the above revelation concerning GP’s views on appointment duration, it further highlights the less sensational news that 93% of GPs believe that their current heavy workload has a negative effect on patients.
Nevertheless, despite the dissatisfaction expressed, half of all GPs feel that their practices should offer some form of extended consultation hours even though less than one in ten of them would want their own surgeries to offer seven day opening. Essentially, and not surprisingly, few GPs seem to want to work at the weekend!
When you have an overburdened workforce, feeling stretched to the limit, it is obvious that they will want to protect the limited time they have off of duty to avoid burnout. It might seem therefore foolish for politicians and others to advocate seven day GP availability to patients, particularly at a time when their morale is extremely low.
As an alternative, 76 per cent of GPs believe that increased funding is required. We can assume large portions of this money would be spent in order to allow more staff to be employed, and specifically to fund more GP posts and the opening of more general practices. Such a measure would enable longer consultation times and bring the facility to offer extended surgery hours without further imposition on GPs.
However, even with increased funding, it is difficult to envisage where more GPs might be found. A recent report from Civitas has included statistics which show that only 60-70 per cent of GP training places are currently filled in some parts of the country and in fact, overall, GP training places have fallen by 15 per cent in the past year. The Civitas report further reveals a current shortage of qualified GPs to fill present vacancy rates of around 12 per cent. This means that surgeries in desperate need of increased staffing are unlikely to have their needs met in the near future.
One strategy to address this lack of staff has been that of enticing GPs from other countries to work for the NHS, sadly to the detriment of the country they are leaving. However, many overseas staff return to their home countries quite rapidly, especially if they are recruited into sectors with poor working conditions within the NHS. If the present system is forced to rely more heavily on locum staff, the inflated costs associated with locum employment would easily swallow up any increased funding if no more fundamental structural changes are to be introduced.
So how should the NHS proceed if it is to meet the GPs concerns? Firstly, it seems crucial that it invests in more GP training, and also to improve working conditions for GPs actually practicing. By so doing the service would be able to attract many more medical students into general practice.
Secondly, the NHS will have to become much more innovative. The BMA survey shows that 64 per cent of current GPs believe that much of their current administrative duties are unnecessary. Were they to be reduced, longer consultation times would be immediately possible.
Thirdly, as is the case in other countries, auxiliary staff could carry out basic procedures such as blood pressure readings and the recording of patients’ weights before they proceed to a GP consultation. These auxiliaries, perhaps specially trained nurses, could also conduct tests after a patient has been seen, giving the GP more time with each. It seems evident that many tasks could be performed by nurse practitioners without compromising the quality of care.
Perhaps, at least in the short term, increased investment in the employment of auxiliaries and locums might ease the consultation overload that so many GPs complain of. However, in the long term, increased investment in GP training, perhaps coupled with the increased delegation of tasks to staff trained at lower levels, seems the NHS’s only sensible option.
Edmund Stubbs, Healthcare Researcher @edmundstubbs1
The primary reason why GPs are under pressure is the huge numbers of immigrants who have been allowed into Britain in the past 15 years. The official figures show net immigration at 3 million since 2000 and the reality is probability a million or two more through illegal entry. In addition the birthrate of immigrants is higher than that of the native population and consequently the British born children of new immigrants have inflated the UK population substantially.
Even if only three million extra people have been placed in the system,the extra burden on GPs is immense. Moreover, many of these people have inadequate English which means that it takes extra time and expense for a GP to deal with them.
Other things such as the Coalition’s shunting of extra responsibilities from hospitals to GPs and the reduction in UK training places from doctors add to the difficulty of recruiting and training GPs, but they are secondary to the sheer volume of additional immigrant demand.