05.05.16
First up-to-date GP data reveals depth of primary care crisis
The GP crisis could be worse than previously thought, the King’s Fund has said as it produced the most detailed and up-to-date data into pressures on GP practices.
The King’s Fund report found that in 2010-15, the number of GP consultations increased by 15%, but the GP workforce grew by 4.75%, less than a third of that amount. The practice nurse workforce rose by 2.85%, and funding for primary care as a share of the general NHS budget fell every year, from 8.3% to 7.9%.
Although the NHS has promised new measures to support primary care in its GP Forward View, the Patients Association said that these reforms need proper monitoring to ensure they work.
Beccy Baird, fellow at the King’s Fund and lead author of the report, said: “Investment alone won’t help the crisis in general practice.
“To avoid the service falling apart, practical support to do things differently is crucial and must be underpinned by an ongoing understanding of what is driving demand and activity. Only then will working in general practice be an attractive proposition and ensure the service remains at the heart of the NHS.”
The King’s Fund said that GP practices could fall apart unless the Department of Health and NHS England immediately provide practical support to them, including accelerated take-up of new technologies, the use of health coaches and volunteers to augment the workforce, reductions in bureaucracy and better signposting of services for patients.
In the longer term, the think tank said that NHS England must improve data gathering and develop new methods of general practice and voluntary contracts for practices to lead the development of integrated out-of-hospital services.
It added that Health Education England must develop a workforce strategy to support GP recruitment and retention.
The report warned that GP shortages are likely to get worse, as it found that only one in 10 GP trainees plan to work in general practice full time and GPs are increasingly retiring early, with 46% of GPs leaving the profession aged under 50.
The King’s Fund data is based on analysis of 30 million consultations at 177 practices and confirms suggestions of a growing shortage in GPs from previous, smaller-scale reports by the Health Foundation and the British Medical Association, which has launched an ‘Urgent Prescription for General Practice’ campaign.
Baird added: “While we have data almost in real time to tell us what’s going on in A&E, the only national-level data we have on activity in general practice is, at best, a year out of date. “It wouldn’t be acceptable to try to run a hospital on out-of-date information and it shouldn’t be for general practice either.”
The report found that the increased pressure on GPs could be due to the increase in patients with complex and comorbid conditions, with a 28% increase in consultations with patients aged over 85.
Although more appointments were being transferred to support staff such as nurses, this meant that the patients doctors did see were more likely to have complex conditions needing more than a 10 minute appointment, again increasing pressure on GPs.
Dr Maureen Baker, chair of the Royal College of GPs, said: “This report provides cold hard facts that confirm what the College has been saying for years – that general practice is suffering under the unsustainable pressures of rising demand and a diminishing workforce.
“GPs and our teams are making more consultations than ever before, and our patients are living longer and with multiple, long-term conditions, meaning that our workload is growing in complexity as well as volume, making the standard 10-minute appointment increasingly unfit for purpose.
“We urgently need more GPs so that we can deliver the quality of care that patients need and deserve. We have seen some promising signs in the latest recruitment rounds for general practice but today’s report shows just how essential it is that we build on this and do everything we can to ‘recruit, retain and return’ as many GPs as possible.
“We should never have reached this point – the lack of national-level data on the state of general practice in recent years enabled many to turn a blind eye to the ever-worsening crisis until our profession was on the brink.”
Katherine Murphy, chief executive of the Patients Association, said that she was “sadly” not surprised at the statistics and that the King’s Fund had received rising levels of calls to its helpline from patients receiving sub-standard care or unable to access any care.
She said: “The only casualty is the patient. There is an urgent need to look at the provision of NHS care in a joined up way and ensure that the patient comes first in every decision made.
“A tipping point has now been reached in primary care. The Patients Association calls on the government to read this report and recognise and respond to the factors which have led to this crisis.”