New research from The King’s Fund exposes for the first time the extent of the crisis in general practice, finding that the overall number of consultations (face-to-face and telephone) has increased by 15 per cent over the past five years, three times the rate of increase in the number of GPs.
Understanding pressures in general practice is the most comprehensive analysis to date of the pressures facing the profession. The report analyses 30 million patient contacts from 177 practices and includes extensive research with GP practices and trainees.
As well as a growth in the number of consultations, it shows that general practice’s workload has become more complex and intense. For example, our research found:
- a 13 per cent growth in face-to-face consultations and a 63 per cent growth in telephone consultations, contributing to stressful and highly pressurised working days for GPs
- the biggest increase in consultations were among the over-85 age group (up 28 per cent), who are more likely to have more than one chronic condition
- using other members of the primary care team to triage and manage minor illness means that the patients GPs do see tend to be the most complex cases, who often require more than a 10-minute appointment
- the move to transfer care closer to patients’ homes hasn’t been coupled with the equivalent transfer of resources to primary care, again increasing the pressure on GPs.
The report also underlines the scale of the recruitment and retention crisis facing the profession, finding that fewer GPs are choosing full-time clinical work – this is true of both male and female GPs. New research for the report found that five years after qualifying, only 1 in 10 new GP trainees plan to be working full time seeing patients in general practice. GPs are also retiring earlier and in greater numbers: between 2009 and 2014, 46 per cent of GPs leaving the profession were under 50; between 2005 and 2014 the proportion of GPs aged between 55 and 64 leaving doubled.
The report follows on from the recently published General Practice Forward View by providing a coherent diagnosis of why and where these pressures in general practice come from. It argues that the Department of Health and NHS England have consistently failed to collect national-level data that could have anticipated the crisis that has now emerged. It says that general practice is at risk of falling apart unless significant additional investment is accompanied by new ways of working that build on current good practice.
As well as improvements to data collection and intelligence the report’s recommendations include:
- placing general practice at the heart of new sustainability and transformation plans to ensure that the voice of general practice is heard and acted on
- developing new and innovative models of general practice (for example, multispecialty community providers) with a balance struck between the benefits of working at scale through federations and networks and making sure services are responsive to local people
- designing a workforce strategy through Health Education England that supports sustainable careers for GPs and their fellow team members, promoting sustainable and fulfilling options for development and recognising changing career preferences.
Beccy Baird, Fellow at The King’s Fund and lead author of the report, said:
‘While we have data almost in real time to tell us what’s going on in A&E, the only national-level data we have on activity in general practice is, at best, a year out of date. It wouldn’t be acceptable to try to run a hospital on out-of-date information and it shouldn’t be for general practice either.’
‘Investment alone won’t help the crisis in general practice. To avoid the service falling apart, practical support to do things differently is crucial and must be underpinned by an ongoing understanding of what is driving demand and activity. Only then will working in general practice be an attractive proposition and ensure the service remains at the heart of the NHS.’