Dr Patrick Pearson shares a letter he wrote to the health secretary and his local MP about the impact of the Budget on general practice
I have been a grassroots GP for 40 years, working as a partner in a local practice which has been established for over 100 years. In that time I have been subject to innumerable reorganisations, updates and changes in work practice, some of which were more welcome than others. I have never involved myself in medical politics and just concentrated on doing the ‘day job’ of looking after our patients. I have witnessed the gradual erosion of what is the cornerstone of healthcare in this country, namely general practice but have tried to get on with it in much the same way as Boxer, the hardworking horse in Orwell’s Animal Farm. As he would say, ‘Must work harder.’
When the new Government took power, there were promises about how the NHS would be revitalised. Wes Streeting prioritised primary care in his first days as health secretary, visiting a GP surgery in London with the chief executive of NHS England, Amanda Pritchard, and explaining that he wants to improve things. This would be a welcome commitment, because GP services have been woefully under-resourced in recent years.
Fast forward to the Budget and what do we get? Basically, a financial kick in the teeth.
The changes in National Insurance rates paid by employers will hit general practice twice. The rates are going up and the threshold for paying are coming down. Despite working for the NHS, we in general practice are not being shielded from these rises like secondary care. I note that the government is ‘well aware of the pressures’ on GPs and that ‘allocations’ for the year ahead had not yet been made.’ If this is the same awareness of the increased costs after the suggested increased pay rates for staff earlier this year and the inadequate increase in GP funding to pay this, then I am not holding my breath.
It is not unreasonable to expect general practice to be given the same protection as the rest of the NHS as otherwise surgeries will be going out of business and shutting their doors.
An increase in the minimum wage has also been announced. Yet again this is likely to impact on GPs costs with no extra funding to cover it.
It feels as if there is a plan to drive general practice out of business. We provide over 90% of health care in this country with less than 10% of the health budget.
We have to live within our means unlike large secondary care trusts. If we run out of money, we lose our livelihood while trusts can run at a loss safe in the knowledge that they will be bailed out.
This erosion of general practice has been a steady process for years with increased demand for services being provided by fewer and fewer full-time GPs. There is no incentive for long serving GPs to stay in work. Previously they were rewarded with seniority payments to show respect for long service and experience. These were abolished but hospital consultants continue to get given Local Clinical Excellence Awards (LCEAs) or National Clinical Impact Awards (NCIAs) which can add as much as £40,000 pa.
The situation is not helped by the lack of funding for premises. We have been trying for over 20 years to build new premises so that we can accommodate extra staff, train new GPs and provide better services. Despite endless meetings with all and sundry, the answer has always been that there are no funds so we continue to do our best in a large converted house.
There is no doubt that the pandemic triggered a sea change in the public’s perception of general practice. We continued to work throughout this showing remarkable resilience and flexibility. True our doors had to be shut for some of the time but we were still seeing patients whenever possible, often with absent or inadequate PPE. The outcome of these times now is that, if any comedian wants to get a cheap laugh, all he has to mention how lucky he is to get an appointment to see his GP. The lack of appointments is not because we are not working; we are, often late into the night and weekends keeping up with paperwork. The real lack is because there are too few of us to go round.
How short people’s memories are. Who was it that provided the bulk of the vaccinations during the pandemic, often in our own time and providing our own PPE?
Consultants, junior doctors, nurses and PAMs (professionals allied to medicine) have all been awarded a well-deserved pay increase.
What about GPs – or is this the straw that breaks the camel’s back?
Yours in hope,
Dr Patrick Pearson
Very eloquent, thank you for sharing.
Every time we are the punchline of another comedian desperate for a cheap laugh, I wince, and then I get angry.
Everyone seems to want to punch down at us, rather than place responsibility where it really lies (with NHSE and the government together) and credit us for holding together a failing NHS at our own financial and personal cost.
They will miss us when we are gone.
Darren – alas I fear we are and they do
“It feels as if there is a plan to drive general practice out of business.”
Yes. That is the plan. Defund, demoralise and break the “small business model “. Practices will close as they become non profitable. They will be taken over by GP businessmen who will not bother much with clinical work. They will own several practices. There focus will be to make a profit. Care will be provided at a level that ticks the boxes for regulators.
Trusts may become involved in the running of primary care. We are working in the painful transition phase.