NHS IN CRISIS: GP numbers in England heading for a '˜cliff edge'
Plans for the reorganisation of the NHS to help save £22bn are putting a greater focus on general practices taking appointments currently done in hospitals - while GPs will focus on patients with the most-complex long-term illnesses and are less likely to see other patients with more minor ailments.
But there are fears the Government’s target of recruiting 5,000 more doctors to the profession by 2020 will not make up for the expected loss of many senior GPs going into retirement.
The recruitment target is part of the GP Forward View plans promising an extra £2.4bn for general practice, as well as an extra 5,000 support staff for surgeries by 2020.
But recent NHS figures have shown the number of GPs in the country dropped by almost 100 in the past year, down to 34,495 full-time equivalents in September 2016 compared to 34,592 the year before.
The Royal College of General Practitioners says frontline GPs ‘are already facing a severe crisis’.
And new analysis by the RCGP of the 44 Sustainability and Transformation Plans (STPs), running parallel to the GP Forward View ambitions and being drawn up across the country to tackle the funding shortfall, has warned they contain a ‘paucity of solutions’ to tackle the workforce challenge.
It says that on average 39 per cent of GPs are aged over 50, ‘a large number of whom will become eligible for retirement between now and 2020/21’.
Up to 50 per cent of GPs are over 50 in places such as Lincolnshire, Somerset and Mid and South Essex.
“Many STPs recognise that there are current and future problems with workforce numbers, often showing awareness of the level of forthcoming retirements.
“Despite this, there is a paucity of solutions or strategy to address these concerns. In numerous instances, STPs indicate that they are intending to make a workforce plan, suggesting that work in this area is still at a very early stage.
“For example, the Staffordshire and Stoke on Trent STP states that capacity and demand modelling will be completed by March 2017, while the South Yorkshire and Bassetlaw STP has each area within the footprint developing a workforce strategy.
“Given the lack of strategy in many areas, there are concerns that lip service is being paid to problems.”
The RCGP report added it is concerned about the way in which STPs view GP numbers in future.
It said: “While a small number of STPs have done a significant amount to reflect the GP Forward View, others fail to mention it at all.
“Many STPs are driven by the need to tackle large acute sector deficits and a number treat general practice as a solution to the problems in secondary care without planning to adequately stabilise and support it.
“Most alarmingly, a number of STPs appear to plan for a reduction in the number of GPs, contrary to the vision of the GP Forward View and despite the planned movement of care into the community.”
Many of the STP documents lay out ambitions for GPs to focus their work on patients with the most complicated medical conditions while other medical staff such as pharmacists will deal with the majority of people currently coming through the doors of surgeries.
In South East London, health chiefs are forecasting a 25 per cent shortfall in GPs by 2020/21, requiring an extra 134 GPs and 82 nurses to be hired if the system is not changed.
One of the ways it intends to deal with is hiring lesser-qualified ‘care navigators’ and physician associates to deal with some patients.
Dr Krishna Kasaraneni, GP workforce lead for the British Medical Association and medical director of the Humberside Group of Local Medical Committees, said those plans go some way to dealing with the ‘reality’ of falling numbers in the GP profession in this country.
In Rotherham, the area where he works, more than one in three GPs are due to retire in the next five years.
He said: “We are facing the cliff edge of a significant proportion of GPs retiring in the next five to ten years.
“From 2009 to now, there are 3,500 fewer full-time equivalent GPs.
“The STPs are kind of acknowledging reality.
“The reality is the amount of work in General Practice has increased significantly in the last few years. The workload is going up and you need a workforce to deliver it.
“There are a section of patients who are living longer than ever before with more complex health needs and they really need time with the GP.
“There are other patients who also access General Practice not necessarily inappropriately but more because of convenience than a needs thing - the working person who wants to see their GP at 6.30pm because they have had a cold for 24 hours.
“It is about trying to plan these things that don’t need an expert in chronic health conditions.
“The reality is there are certain aspects that only a GP can do. You can’t replace a GP with two nurses and a pharmacist.”
The RCGP have also raised concerns about the ‘optimistic’ predictions made in the STPs about how savings will be achieved.
“It is undeniable that ‘do nothing’ deficits arising from the hospital sector are the key drivers of the action plans in most, if not all, STPs.
“The majority of STPs indicate that they will achieve balance or even a small surplus in 2020/21 by enacting their plans. Given the scale of the deficits, this seems optimistic.”
The report added one official in Hampshire has explained concerns ‘which could easily be applied to many other STPs’.
The RGCP ambassador says: “The STP is full of bold statements that savings will be made and various idealistic goals will be achieved, painting an idealistic picture without really explaining the details of how any of this will be achieved… The financial restrictions are colossal, and could only be achieved by a massive reduction (not extension) of services.
“From a general practice perspective, a real concern is that if the proposed savings are not made each year as projected, any money committed to supporting general practice will be at risk.”
The report adds: “Numerous STPs outline some intended spending in general practice. However, concerningly, where the purpose of the funding is explicit, these are almost exclusively intended to deliver new, discrete initiatives (often in support of the other elements of the healthcare system) rather than recognising that general practice is in crisis and needs funding to stabilise it before it can be required to deliver more.”
An NHS England spokesman said: “We are reversing the historic under investment in general practice with an extra £2.4bn a year by 2020/21 - a 14 per cent real-terms increase - and are on track to deliver more GP recruits than ever before.
“The GP Forward View’s initiatives to further boost the workforce are now kicking in and we are supporting local areas to deliver their Sustainability and Transformation Plans, setting out how they will further ensure that strong general practice services remain central to the NHS.”