The Health and Social Care Committee has accused the government and NHS leaders of failing to heed the evidence on the importance of continuity of care, hastening the decline of a uniquely important relationship between a GP and their patients, in the midst of an acute and growing shortage of GPs.
A report on the future of general practice urges Ministers and NHS England to acknowledge a crisis in general practice and set out what steps they are taking to protect patient safety. The committee of MPs warned that seeing a GP should not be like phoning a call centre or ‘booking an Uber driver’, never to be seen again, and noted that care based on a doctor-patient relationship is essential for patient safety and patient experience.
The report has outlined steps to reverse the decline in the continuity of care, making it an explicit national priority with a new measure requiring GP practices to report on continuity of care by 2024.
However, the workforce crisis must be made a priority. The Committee found it “unacceptable” that one of the defining standards of general practice has been allowed to erode. MPs also urged NHS England to champion the ‘personal list’ model and re-implement it in the GP contract from 2030.
‘The future of general practice’ report found that:
- While demand has increased, the number of GPs has failed to keep pace. The Government has made a commitment to recruit 6,000 additional GPs. However, when looking at fully qualified GPs only, there were 717 fewer full-time equivalent GPs in March 2022 compared to March 2019.
- GP practices continue to rely on locum GPs to fill staffing gaps. While the numbers of GPs working as locums has reduced, in June 2022 there were still 1,404 GP locums in total, 70% of whom were working in no other general practice role. Rates of pay for locum GPs tend to be higher than for salaried GPs which makes reliance on them poor value for money. Added to this, locum GPs are unlikely to see the same patients over a longer period of time, undermining continuity of care.
- GPs are choosing to locum to manage their workload and work-life balance, and to ensure they felt safe to deliver care to their patients. This was in essence a self-imposed regulation to allow practising in a safe and manageable way, but as a result at a cost to the system of primary care as a whole. This trend appears to be symptomatic of the difficulties faced in GP surgeries when it comes to a national lack of staffing.
- The consequence of the mismatch between demand and capacity in general practice is that patients are facing ever poorer access to general practice. The 8am phone queue to try to get an appointment is well documented at many practices, and in the latest GP Patient Survey only 52.7% of patients said that they found it easy to get through to their practice by phone, compared to 67.6% in 2021.
Written evidence highlighted further evidence of poor access. For example, a survey conducted by The Patients Association before Christmas 2021 found that 50% of patients had struggled to access a GP appointment, while the Alzheimer’s Society highlighted some of the specific problems that patients with dementia face, such as particular difficulties using the telephone and inappropriate triaging by GP receptionists.
Giving evidence to the committee, National Voices, the patient charity coalition, commented: “Too many people are finding it difficult or impossible to get the help and support they need in a timely manner, and the problem is now so systemic and far-reaching that it threatens the very fabric of the health system’s claim to be a ‘universal’ service.”
Health and Social Care Committee member, Rachael Maskell, commented: “Our inquiry has heard time and again the benefits of continuity of care to a patient with evidence linking it to reduced mortality and emergency admissions. Yet that important relationship between a GP and their patients is in decline. We find it unacceptable that this, one of the defining standards of general practice, has been allowed to erode and our report sets out a series of measures to reverse that decline.
“Seeing your GP should not be as random as booking an Uber with a driver you’re unlikely to see again. The wider picture shows general practice as a profession in crisis, with doctors demoralised and overworked, the numbers recruited not matching those heading for the door. A reluctance by Government and NHS England to acknowledge this crisis cannot continue and Ministers must set out how they intend to protect patient safety in the short term.”
Commenting on the Health and Social Care Committee's report, Beccy Baird, Senior Fellow at The King’s Fund said: “General practice is under significant strain and the latest surveys show patients are finding it increasingly difficult to get an appointment. This pressure comes as a result of a growing and increasingly complex workload, increased administrative burden, difficulties recruiting and retaining GPs, and issues with access.
“Patients being able to see the same staff in general practice contributes to good patient experience, however it has been very difficult for GPs to simultaneously provide both continuity of care and rapid access while facing severe staff shortages.
“Currently there is a shortage of around 4,200 GPs in permanent roles, despite more GPs being in training than ever before. It is also increasingly common for GPs to reduce the number of clinical sessions they work often due to the volume and intensity of the workload, while large numbers are retiring and leaving the profession – with many citing burnout.
“National leaders must address this staffing crisis and publish a long term workforce plan. It is also critical that local health and care leaders work through the newly formed integrated care systems to consider how they will provide support to general practice to improve access in the short term.”
Dr. Farah Jameel, chair of the BMA's England GP committee (GPC England), commented: “This report highlights the crisis in general practice, and has many crucial recommendations which must be implemented as a matter of urgency. Continuity of care is what patients want, what keeps people well, and what reduces health costs. We know that patients benefit from continuity of care, with the quality, strength and consistency of their relationship with their family doctor having a significant impact on their health outcomes.
“Against a backdrop of a global healthcare workforce shortage, we must recruit more GPs and retain every single one currently working in the NHS. Funding more GP training places, targeting under-doctored areas, and empowering practices to recruit the right skill mix of professionals to care for the needs of their community by disabling current barriers are recommendations that must be acted on as a priority.
“The recommendations to reduce bureaucracy and bean-counting, and support practices to provide continuity, if implemented will be good for patients and the NHS. We support reducing unnecessary targets. General practice has evolved, changing to meet the needs of the communities it serves, but with the independent contractor model remaining as the core upon which it is built. We therefore also welcome recommendations to strengthen this model.
“Since data collection began in 2015, we have lost the equivalent of 1,850 fully-qualified, full-time GPs – each one an experienced and talented doctor no longer delivering the care our patients need. It also means that there is then more work for existing staff to pick up, which leads to more pressure, more exhaustion, and the greater likelihood that even more healthcare professionals will either reduce their hours or leave the NHS altogether. This comes with serious patient safety risks.
“The BMA has long said that punitive pensions taxation must urgently be addressed to tackle the chronic staff shortages in the NHS – something which the Committee has reiterated, calling on Government and NHS England to adopt the recommendations laid out in its report dedicated to workforce earlier this year."
Read the ‘The future of general practice’ report here.
