Failing GP service is '˜elephant in the room' during Horton downgrade talks

A Banburyshire GP has raised the alarm about ambitious NHS reorganisation in north Oxfordshire and whether it can possibly work - because GPs are burning out.
Dr. Hugh Gillies, at Godswell Surgery, Bloxham. NNL-170703-154709009Dr. Hugh Gillies, at Godswell Surgery, Bloxham. NNL-170703-154709009
Dr. Hugh Gillies, at Godswell Surgery, Bloxham. NNL-170703-154709009

Dr Hugh Gillies, a semi-retired GP, said he believes a fifth of all GPs are stressed with many suffering depression.

“The Oxfordshire Transformation Plan (OTP) talks of shutting hospital beds and moving even more work from secondary to primary care. That is more work coming our way. It will be the last straw and it wont be cheaper,” he said.

Dr Gillies said pressure on GPs has led Oxfordshire Clinical Commissioning Group (OCCG) to rate some primary care risk as ‘likely and catastrophic’.

The risk rating scores are 20 out of a possible 25. Yet primary care is the lynchpin of the OTP which proposes closing hospital beds, downgrading the Horton and treating sick, frail and injured people in their homes.

GPs feel this extra pressure will be the straw that breaks the camel’s back.

In a speech that shocked a public meeting at St Mary’s Church, Banbury last Thursday, Dr Gillies said: “OCCG January Board papers have a risk register for different topics. Two risks relate to general practice/primary care.

“There is a risk sustainability of primary care will adversely impact on the deliverability of the wider health system and will impact the care received by patients. The score for this is 20 - ‘likely and catastrophic or almost certain with major consequences’,” said Dr Gillies.

“And there is a risk that continued pressure on primary care capacity to deliver services will result in a reduction of access to and quality of services. Again a rating score of 20.”

The OTP is part of the Sustainability and Transformation Plan for Bucks, Oxon and Berkshire West (BOB STP). This in turn is part of a nationwide revamp splitting the NHS into 44 ‘footprints’ and slashing spending by £22bn. Oxfordshire must save £200m and the BOB region £479m.

The first phase of the OTP - which includes permanent loss of consultant maternity, special care baby unit, loss of 45 beds and downgrading of critical care, is currently under public consultation with the second stage - which includes primary care - to be held late this year.

“I am astounded the STP and Oxon transformation plans have advanced so far without recognising the elephant in the room of general practice in crisis,” said Dr Gillies. “Were primary care clinicians involved in the secret plan developments? If so were they not listened to or do they not work in the same GP land we do?”

He expressed serious concern that there will not be a sufficiently robust system to deal with the turnout of patients from hospital beds because of a rapid exodus of GPs.

“Primary care, district nurse and GP workload has increased enormously with increasing complexity and need, with one per cent funding increase. Any further funding comes with more workload expectations,” he said.

“General practice has been left high and dry by changes since 2010 and there is no sign of rescue. One senior GP locum feels general practice as we know it has only two more years left.”

He said GPs regularly work 14-hour days, starting at 7.15am, doing six or more hours of appointments, often with no lunch break and reaching home at 9pm.

“GPs have had to cancel holidays and let spouses and children go on holiday without them. Much of the work is the result of other NHS organisations’ inefficiency.

“The result is many are burnt out and depressed. Many are retiring or going part time. Nationally many newly qualified doctors are reluctant to commit to general practice,” said Dr Gillies.

He said he realised on retirement at 62 that he was also suffering from burnout. Persuaded to return part time, he now provides cover for holidays and absence.

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