Preview of the year: An optimistic outlook… with caveats

Columnist Dr Margaret Ikpoh takes a look at what 2023 could have in store

I’m experiencing a strange sense of déjà vu, as the issues that pervaded us in previous years are mirrored in this year’s forecast. When addressing the system pressures we are under, I like to refer to the three Ws: workforce, workload and wellbeing.

Workforce: The Health and Social Care Select Committee highlighted the need for the Government to take action to increase our depleted workforce and make general practice a more attractive career. Although early evidence suggests the introduction of ARRS roles has reduced patient satisfaction, I cannot envisage a day in practice without their support.

Workload: Our ICBs will need to ensure they have sufficient representation from primary care to allow PCNs and practices to meet the healthcare demands of their wider communities. Key stakeholder engagement needs to continue and must include our secondary care colleagues to ensure we work effectively across the interface.

Wellbeing: One thing the pandemic enabled during lockdown was a period of self-reflection. But many of us may not have had this opportunity as we continued to work relentlessly. We spend a considerable amount of time improving our patients’ quality of life yet we cannot neglect our own. So, here’s my predictive list:

Prediction 1: We will see an expansion of our existing ARRS roles with possibly the introduction of new roles into practice including other doctors (SAS) into primary care in England. If this happens, it is vital that integration into practice teams needs to be well orchestrated to ensure effective managerial and supervisory support in fit-for-purpose spaces.

Prediction 2: An increase in those seeking diverse GP careers. We know some surveys have shown that up to 42% of the GP workforce is considering leaving the profession in the next five years, and the GMC migration study cites burnout as one of the factors leading UK-trained GPs to leave the UK. I predict that an increasing number of GPs throughout all career stages will seek additional career options to combat everyday stressors.

Prediction 3: The Government will restore 11% of the NHS budget into general practice, which would allow for the delivery of the recommendations in the RCGP Fit for Future Campaign. This includes a review of funding formulas that place practices in areas of deprivation like mine at a great disadvantage financially, deepening the divide and inequalities that exist in society.

Prediction 4: Prioritising our wellbeing. We have all witnessed the devastating effects of workload on our profession. I appreciate this is much harder to practise in reality, but the oxygen mask analogies for self-care ring true if we are to provide safe and efficient care for patients.

Prediction 5: Valuing our workforce. We will finally receive the recognition we deserve as GPs from patients and maybe, just maybe, the media. The constant denigration of our profession has driven many would-be GPs away from primary care and demoralised those who chose to stay. A review of the specialist register ensuring parity with our consultant colleagues would also help instil confidence in the profession. 

General practice is considered the jewel in the crown of our NHS. Without it, the NHS would fail. But patient demands will only increase, especially as life gets tougher, new illnesses emerge and old ones increase in prevalence. This will only heighten the anxieties of those we serve. Timely and accurate public health messaging will be needed to manage such expectations.

While access is undoubtedly vital, it cannot be used as a standalone metric to define our value or indeed used as a stick to beat the profession. Continuity and trusted relationship-based care will be key to ensure we remain the bedrock of care in 2023 and beyond.

Dr Margaret Ikpoh is a GP partner and trainer in Hull. A shorter version of her article appeared in the January 2023 issue of Pulse