Dr Margaret Ikpoh lays out her general practice manifesto in the hopes the new government may take note
Dear reader,
For several weeks, the political landscape of our nation has been as frantic as a GP reception on a Monday morning. We have seen weeks of each party vying for our favour and by the time you find yourself reading this, the grand dance of democracy will have unfolded. However, the one thing that remains certain is our position of finding ourselves still caught up in this waltz of chronic uncertainty.
After weeks of digesting several manifestos and party pledges, here is one for our new leaders to consider.
M is for Manifesto
M is for more. Simply put, more GPs please! We are doing more work than ever before for far less and with fewer full time equivalents. This Orwellian ‘must work harder’ approach to managing our workload will, and has already, end in tragedy for many of our colleagues. Our unsustainable workloads are a threat to patient safety.
Access cannot be dealt with in isolation. We now see over a million patients daily. The recipe of historic chronic underfunding, a shrinking workforce and ageing population, means patients will access less of the GP cake. So, I refer back to letter ‘M’.
New roles. We need to pause and rethink any introduction of new roles into practice. It takes many years of practice as GPs to navigate the management of uncertainty and undifferentiated care. The deployment of new roles into practice cannot be justified when we have a growing situation where GPs cannot find work.
IT. We still have many challenges, including a lack of organisational interoperability and increasing cyberthreats. However, there have been leaps and bounds made in the transformation of healthcare – especially regarding: accessing electronic health records; communicating with colleagues; and the increasing use of AI in primary care. We must be mindful of not widening the digital inequality gap especially in areas of deprivation.
Funding- keep it primary care focused, and fair, by revising archaic formulas that disproportionately affect those practices in areas of deprivation. Redirect the river of resources away from the acute sector and instead allow it to flow into primary care. This redistribution will allow for increased prevention at the front door of the NHS whilst helping to relieve the pressures on the back door.
Estates. We need investment in primary care infrastructures that are sustainable and fit for future practice. As the world evolves around me, my current work environment is still reminiscent of the mediaeval era in which it was built.
Stop the dump. An increasing part of my day is dealt with dealing with issues I cannot actually do anything about. We need to reduce the increasing bureaucracy and administration to free up our time to deal with patients who need to be seen. My patience has worn thin with the growing request for letters to ‘expedite’ hospital appointments, the ultimate in delay and diversion tactics.
Training. As a GP trainer, it is demoralising to see that we are training more GP registrars than ever before, but not retaining them once they qualify. We also need support for trainers; many who are struggling with burnout and/or caught between the rock of keeping their practice afloat and the hard place of maintaining supervisory responsibilities for the wider MDT. General practice is also no longer a career of choice for medical students. If we are to double medical school places to 15,000 students by 2031, with just 350 funded places scheduled for 2025/26, there is clearly a lot more work we need to do.
Overseas graduates – over 40% of our GP trainee workforce are from the international community, without whom, the NHS would simply not stand (and it’s on wobbly legs at present). Exploring long-term solutions (particularly around tier 2 visas and practice sponsorship licences) would not only retain more GPs, but demonstrate our commitment to the investment we have already made in training and valuing their contributions to the NHS.
So will this new government bring primary care a new dawn? Or will it merely rearrange the deck chairs on the Titanic? Only time will tell. If we are to survive this new era, our new government must consult, collaborate, and listen to those who look after and care for its people.
Dr Margaret Ikpoh is a GP in Holderness, East Yorkshire. You can find her on X (formerly know as Twitter) @docmagsy
One point I think needs more thought – that GP trainees are almost half from overseas. IMGs may need some additional orientation before fitting itno our NHS systems and cultures, which is still sadly lacking in many areas. But when looking at retention, I think we need to be asking the question whether doctors coming into Britain specifically to enter GP training, are intending to leave and go back where they came from at the end of this period.
Not that we don’t want them. They do enrich our local culture, and even widen our experiences as trainees, trainers, and patients. And not that we mind training overseas doctors to go work overseas afterwards – the NHS tends to get plenty benefit out of them in return anyway. But to acknowledge that many actually come here ONLY intending to get training that they cannot obtain elsewhere (‘yet’ in many cases, but more so because of the high reputation of GB training in GP).
If we start to fail to deliver the high quality training they look for, they may stop coming.
And also because we need to train enough that will stay here afterwards. No, we should not make staying a compulsory part of being trained here, but in order to plan effectively, we need a rough idea whether we are training enough GPs.
I do not blame IMGs for failure to plan the numbers correctly. It is not their fault that nobody here is considering such things when planning training numbers, it is the fault of the NHS managers who are not considering these matters!
And, yes, I get that some will change their minds and stay, unpredictably; but also local medical graduates (LMGs ?) will unpredictably leave GB after training – and that is another issue NHS planners should factor in (not prevent, just consider), but if we need 5,000 new GPs per year, and are only training 5,000, but 40% of them are IMGs who do not plan to stay after qualifying, then maybe we should be considering there to be more of a need for about 7,000 training places per year, not only the minimum necessary ?
I am absolutely against banning IMGs doing GP training (although that did happen to some part-way through training when we joined or left the EU!), nor banning LMGs from doing GP training overseas, or going overseas for a spell after completion, before deciding where to settle, and gaining extra experience, that will always happen, and worse if you try to ban it, but we do need to stop and consider How many are entering GP here each year, and bump up intake until output matches what we need.