Is a capacity crisis looming in NHS general practice?

#GPFUQ 127 Is a capacity crisis looming in NHS general practice? Like global warming all the signs suggest a crisis is coming (see #GPFUQ 128, 130)

#GPFUQ 128 Will there be enough GPs in the future? Not without a miracle. Patients visit their GPs more and bring more problems each time. In a balanced system about 50% of the doctors need to be GPs. Only about one third of junior doctors are being trained to be GPs. NHS workforce planning (see #GPFUQ 129) has failed to provide enough GPs for the growing demands of the population for health care and it needs to steer more doctors into GP careers. We know that general practice is the high volume low cost gateway to higher cost and lower volume secondary care and we should use primary care to soak up the most of the demand and manage most of the risk and then act as vigilant gatekeepers to the rest of the NHS. Increasing GP workload with a decreasing GP workforce will reduce effective gatekeeping and overwhelm secondary care.

#GPFUQ 129 Why is there a gap between health rhetoric and reality?

The politicians must always be seen to promise and NHS managers must always be seen to plan a better service. But without better promises and plans that follow the rules of continuous quality improvement (see #GPFUQ 18), or some luck, a better service doesn’t result.

#GPFUQ 130 Will we have the right sort of GP in the future? Are we training GPs who can and will want to work for their NHS patients for the next 30 years? The GP workforce is changing. There is a new attitude to professionalism that sees being a doctor as a lifestyle choice rather than a way of life. Broadly the new attitude values quality of work and leisure time more than the older values of service and endurance. The GPs we are training may not have the right mix of knowledge, skills, and attitudes needed to service the high demands in primary care and provide high quality general practice (see #GPFUQ 4). GP training currently concentrates on aims and ouputs, but neglects its outcomes and impact. If we have trained the new generation of GPs to need more time for each patient, be more risk averse, investigate more and also refer patients to secondary care more often then we may have trained them to feel more comfortable practising outside of the reality of NHS general practice. The newer cohorts of GPs will gradually lose their value to the NHS as efficient and effective GPs but find more reward as a concierge type non-NHS GPs. We are heading toward private GP work and different ways of providing primary healthcare for the masses.

#GPFUQ 131 Can we cope with so many GPs doing part time working? There are two main types of newly qualified GPs. The minority are those who want a traditional career path and want to work full time and to become partners. The majority are those who want to work part time as salaried GP and many are likely to have unavoidable career breaks for about 10 years. We don’t have any choice we have to cope with the workforce available. We do need to find new career options that balance the needs of part time workers, and their career breaks, with the needs of the patients, the employing practice and the NHS (see #GPFUQ 131). Practices must accommodate both full time and part time workers better. Part time GPs can be employed for 4 session (half days) over 3 days each week. By limiting them to 4 sessions the job is more attractive and family friendly to applicants, minimises the disruption if the GPs take career breaks, but create a stable 4 sessions job with a happy productive GP for 10 years and after that hopefully have either a reliable salaried GP or potential partner who can take on more sessions or more responsibilities in the practice.

#GPFUQ 132 If the only way to cope in the future is by doing things radically different, what does that mean? The leaders in each general practice have to be part of a collaborative learning culture (i.e. everyone is always asking and answering questions about what they do and why they we do it) making sure they are looking at current practice and actively addressing problems and making improvements in all of the following: building better teams, coordinating better care in the different settings (health, social care, community, home), increasing better self care of patients, providing better preventative health for the population and targeted ‘at risk’ groups.

#GPFUQ 133 Should medical schools recruit more men? We are moving from a male dominated profession to a female dominated profession. Arguably both are wrong and we need to recruit a more balanced workforce that reflects the sex and the ethnicity of the population. The NHS is the major employer of medical graduates and this should be part of NHS workforce planning discussion with the medical schools.