Your Doctor can’t see you now

Why are the numbers of full time GPs dwindling?

Author: Altay Shaw
Artist: Zach Ng
Editor: Sara Maria Majernikova

The Doctors’ Association UK (DAUK) wrote an open letter to Health Secretary Therese Coffey on September 20, warning that inaction to support health services and general practitioners will result in a shortfall of up to 8000 GPs within the next ten years. This statistic was somewhat overshadowed within the letter by the DAUK bringing light to the tragic suicide of Dr. Gail Milligan, who had taken her life due to the overwhelming pressures she was placed under. 

The tragic passing of Dr. Milligan highlighted a large divide between the profession as a whole and an outdated viewpoint that GPs are seen as “lazy part-timers,” despite working long hours to meet the needs of patients across the country, leading to increased burnout and the incidence of mental health disorders. But how has the profession reached this situation in the first place? 

What are the challenges being faced?

In 2021, the GP Worklife Survey discovered that 84% of physicians surveyed were working over the scheduled hours, as stated within their contracts with practices. While critics may point out that the majority of those polled work part-time, the hours spent managing, developing, and even teaching students and colleagues are typically substituted. As such, many doctors are being forced to work outside of their contracted hours, causing fatigue within their roles. It should also be noted that this is not an attempt to gain additional hours or salary in most cases. The Royal College of General Practitioners found that the desire to leave the profession for pay or the desire to move abroad was lower than the average for clinical specialties. 

In addition, the average GP practice is now caring for 9596 patients, more than 2000 more than at the same time in 2015. With a higher number of GP partners leaving the profession due to the stress of both managing complex patient lists and trying to achieve typically high goals for community care, the number of practices has reduced by nearly 1200 in the same time period. With an ever-increasing population living with a greater number of morbidities and ongoing health concerns, including the Season Flu and COVID-19, GPs are having to treat a higher number of patients with fewer full-time doctors in primary care than ever before. As a result, they have too much work to do because they have to put together referral letters, blood tests, and appointments. 

What is currently being offered to GPs? 

The Department of Health and Social Care published “Our plan for patients” on September 22nd, reviewing approaches to supporting health care services. Some parts of the press release talked about doctors and making less use of general practitioners (GPs), but it didn’t go into enough detail to explain the extra help that would be given to reduce burnout. Rather, it focused on the need to reduce waiting times. No mention was made in regards to supporting the development or training of new GPs. Nor was there any mention of what streamlining approaches would be offered to allow pharmacists to have autonomy within their practise, and not require GPs to constantly approve minor changes, even when the only difference was the brand name. 

Previously, the government had offered support to GPs through the use of the GP retention scheme. The main goal of the scheme, launched in 2021, focused on reducing the number of individuals seeking to leave the profession through targeted financial support and flexibility in regards to furthering education, e.g., seeking additional qualifications to aid their professional development. This scheme was intended to complement the already-established flexible pay premia for junior doctors completing GP training, which is worth more than £9000 per year (provided they work full-time and not locum).

While the scheme does allow GPs to earn up to £4,000 more per year, it does not provide much in the way of long-term support.  The scheme ultimately lasts for only 5 years, with provisions to extend for an additional 2 years in exceptional circumstances. It is unclear whether any of the pay increases seen would continue into a full-time salaried position within most GP practices. It is intended to help doctors with care responsibilities or academic pursuits because the standard NHS allocation of leave and timetabling does not allow for the necessary time off to ensure GMC registration requirements are met.

However, to access the scheme, doctors need to have actively signalled their intent to leave the profession. In which case, this approach to support seems to be a desperate attempt to stop the haemorrhaging of doctors from the register. Furthermore, the scheme attempts to incentivise the practices to retain the GPs over the doctors themselves. Practices can earn up to four times as much as their physicians do by simply having them participate in the scheme. No guidelines have been disclosed as to how the practices are meant to use the funds, suggesting an even wider gulf is emerging between those disenfranchised and those running the practices. 

Prospects for the Future 

The NHS faces an uncertain period in regards to GP numbers and support eligible within the primary care setting. While a record number of medical students both enter and graduate each year, the numbers required to go into General Practice are not being met. 

With the little support currently offered, it is hard to see how any government targets can be tackled in the short term. To prevent any further loss of individuals from the medical register, harsh reviews and reforms must be implemented.

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