{"id":50262,"date":"2021-05-14T08:15:24","date_gmt":"2021-05-14T07:15:24","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50262"},"modified":"2021-05-26T17:17:42","modified_gmt":"2021-05-26T16:17:42","slug":"if-general-practice-fails-the-nhs-fails","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/05\/14\/if-general-practice-fails-the-nhs-fails\/","title":{"rendered":"If general practice fails, The NHS fails"},"content":{"rendered":"

General practices nationally are <\/span>at breaking point<\/span><\/a>. The current<\/span> crisis in general practice <\/span><\/a>predates covid-19, but has been intensely magnified by the pandemic. Primary care is rightly called the \u201cBedrock of the NHS\u201d dealing with<\/span> around 90%<\/span><\/a> of patient contacts for<\/span> under 10%<\/span><\/a> of the national budget. GPs are seen as the \u201cgatekeepers\u201d to the NHS providing over<\/span> 300 million<\/span><\/a> patient consultations each year, compared to 23 million emergency department visits. If general practice fails, the entire NHS will collapse. When patients struggle to see their GP, work spills into unscheduled care settings including the emergency department, leading to inappropriate attendance and use of hospital services. Despite all this, more and more work is being transferred to primary care without the associated funding or resources.<\/span><\/p>\n

Both the<\/span> British Medical A<\/span><\/a>ssociation (BMA) and<\/span> the Royal College of General P<\/span><\/a>ractitioners (RCGP) recently acknowledged the increasing pressures on general practice. . GP teams nationally are exhausted from the pandemic, struggling with a toxic combination of increasing patient demands, poor retention, and a depleting workforce. GP teams are now more accessible than ever due to digital platforms, dealing with the increased risks and complexities of remote consulting. We have helped deliver over 75% of a mass vaccine rollout alongside routine patient care, while running community covid hot clinics and supporting<\/span> over 1 million patients in the community with long covid<\/span><\/a>. In addition we are supporting the millions of patients waiting for delayed outpatient treatments (<\/span>recent BMA data<\/span><\/a> estimates that between April 2020 and February 2021 there have been 20.07 million fewer outpatient appointments and 3.24 million fewer elective procedures).<\/span><\/p>\n

A year\u2019s worth of GP care per patient costs less than two trips to the emergency department, and for the past decade<\/span> funding for hospitals has been growing around twice as fast<\/span><\/a> as for our family doctor services. Work in secondary care is tariffed, in stark contrast to primary care where we work to a set fee, per person, per year, so no matter whether patients consult their GP every week or not at all, we are paid the same. Commissioners therefore have a vested interest in shifting work from secondary care to the much cheaper primary care which lacks the appropriate funding or extra resources to cope with it.\u00a0<\/span><\/p>\n

Contrary to widespread reports across some sections of the<\/span> media,<\/span><\/a> GP surgeries have remained open throughout the last year, using remote consultations and digital solutions where possible in keeping with<\/span> NHS England guidelines<\/span><\/a>. In addition to performing their regular contracted duties, GPs have also provided significant contributions to the UK\u2019s largest vaccination programme, and data shows that we are<\/span> busier<\/span><\/a> than ever before.<\/span><\/p>\n

At a time when practices are being shut down at<\/span> record rates<\/span><\/a>, staff resignations are rising, and<\/span> over 20% more GPs<\/span><\/a> are presenting with burnout to the NHS Practitioner health service, it cannot be more important to roll out potential solutions to this crisis. Staff wellbeing needs to be at the heart of healthcare delivery. Maslow\u2019s hierarchy of needs is a favourite among GP trainers, but colleagues frequently go without breaks and food. An exhausted GP cannot perform at their optimum capability and ensuring staff have their basic needs met alongside peer support is essential. There is no cap on the number of patients seen in a session,<\/span> with 25 stated as a safe level<\/span><\/a>, but many GPs now report up to 60 clinical encounters in a \u201chalf day.\u201d<\/span><\/p>\n

There is no doubt that every single frontline GP is likely to have some ideas for improvement, and a recent BMJ <\/span>rapid response lists some suggestions<\/span><\/a>. Our leaders need to urgently find practical and achievable solutions, and we would like to present some ideas:<\/span><\/p>\n