Editor Jaimie Kaffash argues that GP partners have a duty to retain and recruit GPs instead of hiring cheaper staff
You haven’t accidentally stumbled on to the pages of the Daily Mail or Daily Telegraph. And don’t worry, I haven’t joined the legions of people whose main hobby is GP-bashing. So let me explain myself, because I am saying this from a place of hope: we can get through the current crisis in the profession, but GP partners have their part to play.
The news this week that a practice is making redundancies among its GP staff feels like a turning point. I didn’t see this coming. I’ve spent a decade reporting on the GP recruitment crisis and, within months, it seems to have been turned on its head. Pulse has reported that locums are finding it harder to get work, and that the number of vacancies partners are offering is decreasing. This followed on from anecdotal evidence that there were increasing numbers of locums out of work, and they are being asked to cut rates.
But the story has shaken the profession. Because it seems inexplicable that this is all happening, yet GPs are still facing unbearable workloads and suffering burnout. It doesn’t make sense. And as a result, we are being forced to reassess what we understand about the pressures in general crisis.
I am still not sure how we have ended up here. It is partly due to the success (and I use that word advisedly) of the additional roles reimbursement scheme in England. This staff has helped alleviate the recruitment crisis, which was the main target of the scheme.
But this has also brought about unintended consequences. Some, we could foresee: work that traditionally required the skill of a GP now being done by healthcare professionals who – although they have great skills themselves – are less qualified than GPs to carry out this work.
Other consequences were not quite so obvious. In 2019, nobody could envisage GPs being out of work because of a lack of vacancies. These new roles were to supplement the GP workforce, not replace it. Yet it seems this is what is happening.
There is an obvious reason for this. The cost-of-living crisis has meant that the circa 2% annual funding uplifts for general practice have led to huge real-terms cuts for practices. They need to save money from somewhere to cover expenses and using the low-cost labour provided by ARRS instead of hiring GPs is an obvious way, and completely understandable.
It goes without saying that GP funding should be uplifted. The five-year funding agreement is over, and the Government and NHS England have no excuse now. We also have a strong GPC leadership that will use everything in its powers to ensure a contract is good for practices – and will pull levers if it isn’t. I also think the Government would be foolish not to increase funding – when this is the main barrier to patients receiving an improved service, it seems like a no brainer in an election year.
I have suggested that GPs be added to the ARRS and, while I think this is most likely, it is not my number one solution – that would be scrapping the ARRS and putting all that money in the global sum to allow practices to spend it as they see fit.
But either way, this is where GP partners’ duty comes in, because with great power comes great responsibility. So if this funding is increased, it needs to be spent in the right way: ensuring everyone in the practice (including partners) receives pay rises appropriate during a cost-of-living crisis; hiring the professionals who will provide the best care – ie, GPs; and most of all, retaining all your current GP staff.
Now, 99% of GP partners will be doing this (and I wouldn’t blame you for being annoyed that I’m even making such suggestions). The problem is, the 1% who do choose to use cheaper staff will be the ones who will be held up as representing all GPs. They’ll be the ones perpetuating the greedy GP stereotypes, and will give the Government and the NHS ammunition to be overly prescriptive in how funding is used. This would be a bad thing for GPs and patient care.
So if you haven’t already fired off your emails in disgust, or commented below the line, know this: the crisis in the profession has nothing to do with GPs. But once the NHS and the Government do what they are supposed to, GPs can be the ones to pull us out of the mire.
Jaimie Kaffash is editor of Pulse. Follow him on X (formerly Twitter) @jkaffash or email him at editor@pulsetoday.co.uk
Very wise as always.
Qw
General Practice has become an administrative exercise. Taking a history, examining a patient with consistency of care are all so last centaury. The trend was there before Covid but that was the final nail for primary care. When I went to my GP I was told they had taken down all their Snellen charts as anything to do with eyes go to an optician, and then the hunt was on for a patella hammer.; the telephone consult had invaded the consulting room. So now GP work is reduced to working on the computer one way or another, so you can see why the thinking is anyone can be trained to do that and don’t need expensive GPs. It will come back to bite them, but as we no longer have to pay for our indemnity who cares?
Meanwhile, back at the NHSE HQ, “GP share of NHS spend is falling to eight-year low.
Share of funding for general practice falling and it is now at lowest point since at least 2015” Parliament figures.
Spot on.
What the public might like to see is number of GP appointments per £of total NHS income coming into a practice. With the very confusing pay structure and the longstanding ability of practices to make sure they claim what they can this is not obvious but when the increasing arguments about what is core and what is not and therefore wont be done (ear syringing, , ecg., peak flows seeing as an urgent fit in an ill baby etc) wont earn any public loyalty. I write as someone from the old style ‘do everything clinically safe’ which made work more professionally enjoyable though I also understand the pressures the government has deliberately put in the way of doing this. Dont let us become like dentists .Private only for those who can afford it.
Am sure Partners are trying their best. This is not their making. We cannot attempt to tarnish folk based upon a single corporate practice decision, regardless of how well covered in the media. Our practice profits are down by 18%, our locum doctor spend up by 200% utilities up (gas 600%!!) We have completely run out of room to put any team member into and come April have a national living wage issue that will stretch large portions of staff straight into a minimum wage bracket without any ability to forecast as there is no news on whether practice funding will increase to even partially accomodate this. Practices across the country are in, no doubt, very similar positions and as such when they have taken a wage hit of 20% on average with so much uncertainty it is understandable that they may have pivoted to protect the longevity of their practice for patients, staff and themselves whilst this hopefully rights itself 🙏🏻
You either have Drs providing primary care clinically or you don’t. We used to do it that way but we’re moving to a system where we don’t. The result will be much much more expensive. The reasons seem complex but it’s fundamentally caused by ignorance. GP partners wont fix this, they cant. At some level the UK as a whole genuinely believes primary care is simple and you don’t really need Drs working there. The result is what we see. Its stupid..but take a look at the UK these days ..the UK these days IS stupid and has given up on sensible.
Spot on AB
There is a cognitive dissonance between the oft stated view that x% of patients are somehow presenting with trivia or easy problems combined with the view that only a GP can see patients in primary care.
We triage all our patients. The triaging is done by GPs with full access to the electronic records. For us the loss of Gp direct consulting time doing this is less than the better management of our acute / semi acute / routine requests; rapid closure of requests not needing a full 15 minute GP appointment; capacity to respond to unavoidable urgent requests such as ambulance or other professional calls and end of life / vulnerable patient contacts. Our appointment numbers are in the top 20% for the country, with all face to face slots being 15 minutes or more.
We have used this system both with and without Physician Associates, depending on recruitment, but it is possible, given our system, to appropriately allocate cases to other clinicians, including Physician Associates and GP registrars at different levels of training ie first week in ST1 or last month as ST3. We also have appropriate supervision for these staff. Our nurse are supported to manage long term conditions and we have had nurse practitioners in the past.
It isn’t natural to many GPs, who arguably work in isolation in their rooms, but this doesn’t mean all practices who use non fully qualified GPs for clinical activities are somehow exhibiting a moral failing.
This doesn’t mean I approve of ARRS funding tied to certain roles, but we trained and used Physician Associates successfully prior to ARSS and are remain comfortable with employing, developing, supervising and working with them now.
Simon – cognitive dissonance is a term used to describe two incompatible/conflicting ideas held simultaneously by the same individual. Stating two incompatible ideas one after the other doesn’t demonstrate dissonance. It simply demonstrates two opposing points of view, in this case, generally held by different people. We are in this mess precisely because fools take the existence of trivial presentations as “evidence” that Drs aren’t needed in much of primary care. It’s not true. Triage is an emergency based concept. Its great for prioritising resources to those in greatest need in emergencies. Primary care is not an emergency service. Presentations are vague. People present for one thing but actually need to be seen for another. Theres a lot of rubbish but sometimes the danger is hidden. Triage will ‘routinely’ miss all of this. This doesn’t matter if there is someone to pick up the pieces but if you are the service that picks up the pieces then you are screwed. You are using triage because the system is collapsing. It is not the solution it is a sign/symptom of the problem. Its widespread introduction heralds collapse not any kind of longer term solution. Not all trivia is trivia. Some of it hides an iceberg and these ice bergs are sinking your ship.. The fact Drs these days are only paid well when they’re being managers illustrates everything beautifully. You are managing decline, doing a job you weren’t trained to do and missing the point entirely
Excellent points AB. One of the ways to view the splits in our profession is between those who still follow the venerated tradition of whole-person care (holistic, if you like) which deals with the full picture of the voiced, unvoiced and unknown aspects of the vague presentations by people of varying literacy, language and communication levels, and those who believe these presentations can be atomised (even without obtaining the full picture). There used to be both wisdom and cleverness in the art and science of general practice, but this is being cast out in the headlong rush to “algorithmise” what we do. No doubt it’ll then be easier for inorganic AI to take it over. The dehumanisation of care in order to better monetise it down to the particulate level. Good news for the corporations/billionaires…If only the next government has the guts to make a grand decision whether we follow a Nordic-type model or slavishly give in to USA interests.
I would agree with Simon – there is a time and a place for a 15-minute Roger Neighbour-inspired epiphany that only a GP could create
But the Monday morning duty list is probably not it