Coast to coast

Pulse editor-in-chief Jaimie Kaffash shares his findings from the workforce white paper in light of the health secretary’s comments about ‘coasting’ GPs

As many of you may already know, I have recently taken a step back from the day-to-day running of Pulse, leaving it in the very capable hands of Sofia. My last couple of months have been spent focusing on our white paper on workforce, which attempts to explain how we are in the midst of both a recruitment crisis and an unemployment crisis at the same time.

For the report, we surveyed 2,300 primary care professionals, interviewed more than 150, and analysed 250 pieces of data on every GP practice in England. It is no exaggeration to say I have been dreaming about spreadsheets. This research demonstrated what we already knew – that the problems within general practice are 99% systemic. Whatever way you look at the data, general practice struggles more in deprived areas, with lower funding and with higher percentages of non-white patients.

Some practices in more affluent areas have solved all their recruitment problems, but in those areas, GP unemployment is higher. Practices in more deprived areas have to pay over the odds to recruit, despite bringing in less money and facing greater demand.

The additional roles reimbursement scheme has distorted everything. But practices – with inadequate premises and reduced funding – have little choice but to employ non-GPs.

There is far more nuance than this in the full 50-page report. And there is plenty that the report wasn’t able to cover around the systemic issues in general practice, the NHS and society as a whole – all of which play into patient access.

I would obviously urge you to read it (though admittedly I have a vested interest). But I know one person who certainly hasn’t read it – the health secretary. His explanation for the issues in general practice is far simpler – it is ‘coasting GPs’, as he said in an interview with the Health Service Journal.

It might be that there are some GPs who ‘coast’. You know what other profession includes coasters? Every single profession that has ever existed. And although I have no hard data to prove this, I would suggest that general practice has far fewer coasters than pretty much any profession you can care to mention. 

Mr Streeting talks about ‘poor performing’ practices ‘dragging down’ general practice, with some practices ‘not working as hard as they could’ and creating ‘unwarranted variation’ in GP services around the country. But I have spent the last two months staring at these figures. Whichever way you slice it, there are indicators about why a practice would be ‘poor performing’ and none of them involve partners sneaking off at 4pm. It is telling that he makes reference to GPs working until 2am, adding ‘oh, but we don’t want that’. So why is he making the contrast with ‘lazy’ GPs in the same sentence then?

I have always said that, whatever my thoughts on his policy, Mr Streeting is a smart individual who I think does understand the issues in the health service. But this makes his comments even worse because I genuinely believe he knows better than this.

Our white paper came up with recommendations around workforce that Mr Streeting would do well to heed:

More funding: There are staff available, and there are positions that need filling. The main barrier is the funding to pay for this, which has come from years of 2% funding increases at a time of huge inflation and more expenses.

More funding to deprived practices: We need to reform the Carr-Hill formula – currently, deprived practices have less funding than those in more affluent areas that have an older population.

Remove restrictions from the ARRS: General practice owners know best what staff they need – and that doesn’t necessarily mean PCNs.

Expand premises and encourage training: The majority of GP premises need to be improved. Pre-2015 buildings didn’t take into account the expansion of non-GP roles that began around then; many practices are unable to accommodate new staff, whether that be GPs, nurses or other healthcare practitioners. Training of any staff can’t take place without the physical space.

Promote general practice as a flexible career: Instead of seeing more GPs working less-than-full-time as a weakness, we should see it as a strength. Flexible working is a positive element of the job, and this will bring more medical graduates into the profession.

These recommendations are not groundbreaking, and may seem obvious. But the final recommendation is the most important – no shortcuts. Minor initiatives are no doubt well meaning, and may well bring about positive changes for a small number of practices. But they will not address the structural issues around the general practice workforce.

By blaming ‘coasting GPs’, Mr Streeting is taking a shortcut. By telling ICBs to identify GPs ‘not working as hard as they could’, and blame them when they can’t find these ‘coasting’ GPs, he is absolving himself of the hard job of addressing systemic issues.

If Mr Streeting is genuinely concerned about the variation in GP practice performance, I’d be more than happy to discuss this with him. It might be a long chat, however.

Jaimie Kaffash is editor-in-chief of Pulse