Martin Marshall: We need long-term, realistic, and tangible solutions to solve the crisis in general practice

This week’s announcement gave us a short-term sticking plaster that will do little to improve the morale of our beleaguered profession or the care we can deliver to our patients, writes Martin Marshall

The call for more face to face GP appointments have become part of the national conversation of late, so we expected GP access to be a focal point of this week’s government announcement on NHS funding—but we didn’t expect it to be the sole focus.

At the Royal College of General Practitioner’s annual conference in Liverpool this week, the frustration and disappointment among our members has been palpable.

While £250m for general practice is a significant sum of money, it’s the tip of the iceberg when you consider that this needs to be shared across over 7,000 GP practices in England. It may help get us through the winter—assuming that locums are available in areas of need—but achieve little beyond that.

Sharing some of the responsibilities for prescribing and writing fit notes is a welcome development, but falls a long way short of the system-wide programme needed to cut the box ticking and paperwork that fills up GP’s days and takes us away from frontline patient care. Reducing the burden of bureaucratic QOF on practices would have been a more positive step forward.

Earlier this summer the RCGP published our own “‘recovery plan” for halting the crisis and protecting the care of our patients and the wider NHS by investing in the hardworking GPs and their teams who provide that care. Yet our realistic and tangible solutions have been largely ignored.

Every patient should have good access to a GP, but the government’s obsession with access is a major distraction from the very real workforce and workload pressures that are preventing GPs from giving their patients the care they need and deserve.

It also fuels the rhetoric that GPs are “refusing” to see patients face to face which, as well as being inaccurate and unfair, undermines the bond of trust that GPs have with their patients.

GPs go into general practice to care for patients, and we share their frustrations when they experience long waits for GP appointments, but the claim that face to face consulting isn’t happening is wrong. Almost six in 10 consultations are currently face to face—that’s nearly 14 million in a month. The RCGP has always been very clear that a blend of remote and face to face consultations are necessary, and that post-pandemic this should be a shared decision between GP and patient. We know some patients prefer to see their GP face to face—but good care can, and is, being delivered remotely and some patients prefer it.

Regardless of how our patients access GP services, they deserve safe care and there are limits beyond which we can no longer guarantee this, especially when an individual GP is now responsible for an average of 2000 patients—this is 5% higher than just six years ago.

Yet this week has also prompted the resurgence of allegations that long waiting times for a GP consultation are caused by GPs working “part time.” But if you actually look at the hours worked by a “part-time” GP working three days a week, they are longer on average than what would be considered full time by most people—around 40 hours. A quarter of GPs are working 50 hours a week or more. To put that into context, a pilot is restricted to flying 32 hours over seven days because doing more would be considered unsafe.

GPs have worked to their limits over the last 18 months and ensured the delivery of essential care and services to patients when other parts of the NHS shut down.

Despite this, hardworking GPs continue to be vilified and scapegoated from all directions. The plans to increase more scrutiny of hard-pressed practices and the introduction of an arbitrary text message service to rate the performance of particular GP practice will further demoralise a profession that is already on its knees. Ironically, this could lead to more hardworking doctors leaving the profession before their time.

The longstanding problems in general practice—resulting from more than a decade of under investment by successive governments in the family doctor service—have only been exacerbated by the events of the past 18 months and the supply of GPs is falling far short of patient need and demand, which is rising both in volume and complexity.

While previous experience has taught us not to expect a miracle cure, this week’s so-called rescue package is yet another missed opportunity.

We need long-term, realistic, and tangible solutions to solve the crisis in general practice. This week’s announcement gave us a headline-grabbing, short-term sticking plaster that will do little to improve the morale of our beleaguered profession or the care we can deliver to our patients.

Martin Marshall, Chair of the Royal College of GPs, a GP in East London, and Professor of Healthcare Improvement at UCL. 

Competing interests: none declared.