London’s primary care services are in a critical condition. Asking already over-burdened GPs to deliver seven days a week care, without the appropriate funding to increase the number of GPs, will exacerbate London’s spiralling NHS crisis.
But on Monday, that was exactly the request our prime minister and health secretary made.
General practice in the capital, and across the country, is vastly overstretched. Too few doctors are expected to deliver care to a growing and aging population with multiple needs. A much more diverse demographic has increased both workload and the complexity of conditions now being looked after in general practice. .
Fewer doctors are choosing to enter general practice, whilst the pressure of work has led to increasing numbers of GPs leaving the profession early.
Yes, we should provide round-the-clock care, but it has to be appropriate care delivered by the most appropriate professional in the appropriate setting.
Let’s be honest with the public: reform of this kind, and on this scale, cannot be delivered unless it is matched by the funding and working conditions necessary to recruit, support and retain hardworking GPs. Without this, the government’s proposals offer little more than false hope for the public and increased patient dissatisfaction.
The last government’s £3 billion restructure has taken its toll. Our NHS is under resourced and staff are overworked. Last year alone GPs conducted over 340 million individual consultations nationally, with the number of consultations in London rising steeply. Yet the number of nurses and GPs has simply not kept pace with increasing demand.
Doctors are now no longer just expected to look after their patients but also manage budgets, ration care, deal with government cuts and manage patient expectations. GPs have had to form Limited Companies to bid to provide services for their patients which Clinical Commissioning Groups are required to tender out. This all flows as a consequence of the Health & Social Care Act 2012.
Increasing demand on time outside the practice has led to more pressure on GPs. The morale amongst clinicians is at an all-time low. In last month’s BMA survey of nearly 16,000 GPs, one-third said they will be taking early retirement, going part-time or emigrating by 2020.
In England, 40 per cent of GPs are over 50, whilst in London almost 16 per cent are over 60 years old. Many are choosing to retire early rather than become embroiled in the burdensome CCG system, and the result is that many single handed practices are forced to close altogether.
Progressive GP practices are embracing technology and new ways of locality based working to improve patient access. However, more investment is needed to bring GP premises and IT systems in line with the demands of modern day primary care.
Health and Social Care needs to be integrated and designed around the patient. Patients need be at the centre of service provision rather than being seen as a complication to the design process.
It’s clear that a great deal more needs to be done to make general practice more attractive to new entrants and to make those who work in primary care feel emotionally rewarded for their work. The GP Contract has been made a scapegoat for the NHS Crisis, which does nothing to raise the morale of the medical profession.
Promises of a seven day GP service, with no mention of how it will be funded and delivered, will do nothing to alleviate the concerns of the workforce. Patients themselves will see little benefit.
We’d all like to see surgeries properly staffed and open seven days a week. But if round the clock care is to improve patients’ experiences, it must be matched by the funding necessary to recruit, support and retain hardworking GPs.
Dr Onkar Sahota AM is Labour’s London Assembly Health spokesperson as well as a practicing GP in West London and chairman of the Assembly Health Committee. Follow him on Twitter