Following a period in which many GPs have felt undervalued and undermined by successive governments it is pleasing that Jeremy Hunt has recognised in today’s speech the quality and value General Practice delivers to the NHS, writes Dr Kate Owen a GP and Principal Clincial Teaching Fellow at Warwick Medical School.
He also accepts that the profession is not in good shape; a recent BMA survey suggests that 1 in 3 GPs are considering retiring within the next five years and more are considering moving abroad to work. Excessive workload is cited as the main driving factor.
His response to the problem is to offer a carrot and stick approach. The carrot- investment in 5,000 more GPs and additional practice staff, investment in premises and incentives to work in under-doctored areas; the stick- seven day working. There are problems with both carrot and stick.
The Royal College of General Practitioners (RCGP) and BMA agree that increased numbers of GPs are required, though suggest that the number needed is 8,000 by 2020. Currently GP training programmes across the country are unfilled, leaving doubt over whether we can train the required number of GPs. Health Education England (HEE) required medical schools to aim that 50% of their graduates enter careers in General Practice. Warwick is one of the schools with the highest number (40%), the lowest is 16%. We need to promote general practice as a positive career choice to our students, emphasizing the variety of work, opportunity for portfolio careers and the satisfaction of providing holistic, patient centred care to patients who we have known over years. Our local GP placements are highly rated by students, but longer placement lengths would allow students to experience the value of longitudinal patient care. Perhaps we need to go back even further to recruitment and investigate how we recruit students who are likely to be suitable for general practice.
With the ongoing movement of patient management, particularly around chronic disease, moving from secondary to primary care and increasing numbers of GPs with special interests the opportunity for an extra year of specialist training is to be welcomed, however this should be available to all trainees. A 4th year of GP training was approved by Medical Education England in 2012, but funding for this has been repeatedly stalled. Increasing GP skill sets would improve primary care quality and may have positive effects on recruitment.
Patients already have access to a GP 24 hours a day, seven days a week through GP out of hours services. Most practices now offer “extended hours” appointments at evenings and weekends for working patients. Most practices report low demand for these appointments; the majority of consultations are with older people and children who are able to come during the week. Initiatives to reduce A+E attendances should direct patients towards GP out of hours services or build on work from pilot studies where GPs are employed to work in A+E. It is difficult to see what benefit there will be to increased opening times, particularly as it is likely that practices will group together to provide this access so patients will be unlikely to see their own GP and often not even a GP from their own practice.
The government at last are recognising the challenges to primary care, but would benefit from more consultation with GPs regarding potential solutions rather than sticking with headline election pledges which are unlikely to provide value for money or improved quality of care. As a profession we need to examine how to better convey the many interesting and satisfying aspects of our work. As a medical school we need to provide more opportunities for students to experience primary care.
Contact Nicola Jones, Interim Communications Manager, University of Warwick, N.Jones.firstname.lastname@example.org, 02476 150868, 07824 540863.
Interim Communications Manager
University of Warwick
tel: +44 (0)2476 150868 or
+44 (0)7824 540863.