Chaand Nagpaul: ‘The Government’s NHS plans depend on supporting GP wellbeing’

Ahead of his keynote speech at Pulse LIVE Leeds, former chair of both the BMA and its GP Committee Dr Chaand Nagpaul discusses how the Government needs to focus on GPs’ wellbeing if it is to deliver the future of the NHS. For more information on Pulse LIVE Leeds visit our dedicated site

I fought to be a GP in the halcyon years over three decades ago when it was a fiercely competitive specialty; 180 applicants for two places on my GP vocational training scheme, and 80 applicants for the partnership position I secured. This was a time when it was almost unheard of to retire before retirement age – with many working beyond then – and being a GP was both a profession and vocation. I’m rooted in being proud and privileged to be a GP.

Tragically, the landscape is now a world apart. Many of my peers have retired early due to excessive workload demands and feeling exhausted and professionally demotivated. Others have reduced clinical sessions to protect themselves, and many newly qualified GPs choose to work less than full time from the outset due to a job that otherwise feels unmanageable. While the UK was once an international beacon of general practice, the Commonwealth Fund has relegated UK GPs as being the most stressed and least satisfied in their work compared to equivalent OECD nations.

The scale of mental distress is itself deeply distressing. One in five GPs recently surveyed reported having thoughts of self-harm during their career, attributing this primarily to their job. Without intervention, the situation will only get worse. The moral injury of GPs unable to do their best for their patients within inadequate time and limited resources is endemic. At the same time, we have the Government’s mantra of moving swathes of work from hospitals into the community which is at odds to the reality on the ground of a system that is a already creaking with oversaturated GPs and practices.

We need urgent and decisive action at both government and local level to invest in an infrastructure of general practice that has wellbeing at its heart. That means delivering on the Darzi report and the 10-year plan for a seismic increase in the proportion of NHS funding in general practice and primary care. This would mean that that we work in modern, fit for purpose premises that support our wellbeing with the space to care, learn, teach, rest and meet. It would mean a system in which practices are resourced to employ the entirety of our GP workforce, ending the perverse irony of GP unemployment – so that there are enough of us to have longer appointments and time to care for our increasingly older and complex patients with multiple morbidity.

We need action that ensures that GPs want to come to work, and feel professionally rewarded, rather than choose strategies to avoid the pressure. This includes a new GP contract which ends the unlimited shifts in unresourced workload and inappropriate demands that saps our morale daily. A contract that gives us paid protected time – as our hospital colleagues do – to professionally learn and develop within our working week and can have the basics of lunch breaks to prevent continuous 12 hour days.

The Government’s ambitious 10-year plan is predicated on general practice playing a central part as the ‘front door’ of the NHS. These plans will remain nothing other than ambitions, until and unless we see these translated into a reality where we have the capacity in primary care with a motivated healthy GP workforce, with the time, tools and support to provide the care that our patients so desperately need.