BREAKING MEDICAL NEWS
TRAINING CRISIS THAT IS ENGULFING THE PROFESSION
From the News Desk of Jeanne Hambleton
Source Pulse Today
Posted 22 Juy 2014 By Jaimie Kaffash
Leaked figures reveal almost 40% of GP training places are unfilled in some areas of the UK, finds Jaimie Kaffash.
This was not meant to happen. Since 2012, the Government has been saying it wants at least half of medical training places to be for general practice.
But leaked figures obtained by Pulse reveal the worst training recruitment round for seven years, with some areas seeing almost 40% of places unfilled. The figures have been described as ‘alarming’ by GP leaders, with serious implications for the profession.
They undermine one of the main pillars of the Government’s health strategy and have all but extinguished the light at the end of the tunnel for GPs in certain areas, who saw a new generation of GPs as the answer to the unsustainable burden of workload.
There can be no positive spin. The 2,630 graduates entering training in England in August is the lowest number since figures were collected in this way in 2007.
In the North East, fewer than 70% of posts have been filled, while Health Education Yorkshire and Humber has only filled 78% of its posts. Health Education East Midlands is bottom of the table, filling just 63% of its places.
Indeed, the short-term crisis is so severe that Health Education East Midlands has instigated a ‘pre-training year’, which will see graduates who failed the GP training assessments fill gaps in secondary care.
The Government has already had to extend the deadline for its target of 3,250 GPs entering training annually by 2016 in England, but even this is looking optimistic now.
Dr Beth McCarron Nash, a GPC negotiator, says the figures are ‘extremely alarming’. She says: ‘Many GPs are already feeling it on the ground. We are looking at alarmingly low numbers of people applying for partnerships and salaried jobs. These recruitment figures will only make things worse.
‘We are not training enough GPs to fill current vacancies, let alone the urgent expansion of GPs we need to help us deliver the increased workload we are seeing as a result of the complexity of care and co-morbidity as patients are getting older.’
‘In three years’ time, we will have no GPs coming through to fill our vacancies.’
Doncaster LMC chair Dr Dean Eggitt.
Overall in England, only 89% of the 2,994 posts available were filled – which compares with figures of around 98% for the past four years.
There is little problem with recruitment in London, where some 99% of positions have been filled, and the Kent, Surrey and Sussex and Thames Valley regions are not far behind.
But parts of northern England and the Midlands have massive gaps in their GP training programmes. Scotland and Wales – although not under Health Education England’s (HEE) jurisdiction – are also struggling with around one in 10 places lying vacant.
In Doncaster – where Pulse reported a practice was forced to offer a £20,000 ‘golden hello’ to a new partner as a result of the ongoing GP recruitment crisis in the region – only six of the 26 vacancies have been filled, says Dr Eggitt.
Dr Eggitt says: ‘For general practice, our concerns are that the trainees are supernumerary to us now, but in three years’ time, we will have no GPs coming through to fill our vacancies.’
‘There wouldn’t be enough trained GPs to replace all those who will go even if we filled all the places’.
Dr Nigel Watson, chair of Wessex LMCs
He says the LMC has just conducted a workforce survey of around 130 GPs, which shows that around 30% of the workforce intends to retire in the next five years.
‘If we are losing 30% of our workforce in five years’ time, and only six GPs are coming through, how are we going to fill that gap?’ he asks.
This is the reality shared by GPs across the country. As Dr Watson puts it: ‘There wouldn’t be enough trained GPs to replace all those who will go even if we filled all the places. So the fact that all the places are not filled – and that those who are coming through might not want to go straight into general practice – means we are going to face a problem in the number of GPs coming through.’
Former RCGP chair, Professor Clare Gerada, who estimated last year that 10,000 additional trained GPs were needed to keep up with patient demand, says these figures will inevitably affect care.
She says: ‘GPs now make up 30% of the medical workforce, which is disgraceful. If these training numbers do not improve, we will find that our patients will see longer waits to see a GP, more fragmentation and massively increased costs.’
The coalition Government and the Labour Party both acknowledge that their plans for more care to be provided in the community, with greater continuity of care and better access, are predicated on increasing the number of GPs.
This is reflected in the Government’s mandate to HEE, which tasks the body with ensuring that 50% of all medical graduates – translating to 3,250 graduates – should enter general practice training.
‘We need urgent action from NHS England’ Professor Clare Gerada.
The deadline for this target has already been pushed back from 2015 to 2016.
Dr McCarron-Nash says: ‘I don’t think they can fulfil their own target.’
Even the Department of Health admits its plans are being undermined by training recruitment being kicked into reverse.
A DH spokesperson told Pulse: ‘HEE has created more training places for GPs, but this will only make a difference if the places are filled by doctors in training.
HEE is putting robust plans in place to make sure the training places are filled over the next two years.’
But this action is slow in coming. Professor Gerada says: ‘We need urgent action from NHS England, addressing the short, medium and long term. We need a new recruitment, retention and refreshment strategy and we need this centrally, not just relying on local areas to find their own solutions because it is too important.’
There seems to be no clear strategy to solve the problem. HEE is being accused of having ‘buried’ a report on boosting the GP workforce, with no definite publication date announced.
As Pulse reported in February, the ‘GP Taskforce’ report was set to recommend a cap on the number of secondary care training posts available so that more trainees would have to go into general practice, and that practices be given grants of £20,000 for their premises so they can create more space for trainees.
Patients risk becoming ‘bereft of a GP service’ in some areas, GPC warns
Dr Chaand Nagpaul: ‘General practice is not just in crisis; it is imploding’
But these radical ideas have yet to see the light of day, and the BMA has accused HEE of ‘burying’ the report.
Dr McCarron-Nash says: ‘We have written to HEE asking them why it have failed to publish its own report.
‘It is unacceptable that this report has been buried. This needs implementation and not burial, and these figures underline that fact.’
Pulse understands there is concern among HEE leaders over the recommendation to cap the number of secondary care posts, but HEE refuses to say why it has not yet been published.
HEE says: ‘The GP Taskforce report was commissioned before the establishment of HEE. However, although it takes a very specific GP view, it will be helpful information to consider as part of our work with partners like NHS England around the wider primary care workforce as set out in our mandate, and it will be published on our website in due course as one of the resources for this wider work.’
But, for GP leaders, the real solutions will need to come from fundamental changes that get to the core of the recruitment crisis.
As Dr McCarron-Nash puts it: ‘It is the constant negative portrayal and media bashing we are seeing. We need to urgently get the DH to start talking up general practice.’
‘The profession is now facing a perfect storm’
These are the worst figures we have seen in GP recruitment since GP training was standardised in 2007.
Both the numbers of trainees entering general practice and the percentage of positions filled have dropped. This has particularly hit the north of England, the Midlands, Scotland and Wales.
What is worrying is that, despite highlighting the issue on a regular basis, not enough has been done to promote general practice as a positive career option for young doctors.
In the short term, we would like to see the returners scheme prioritised, to allow already qualified GPs to return to work, rather having to go into this ‘pre-training year’.
This ‘pilot’ is simply an exercise whereby GP training funds have been directed to non-training posts to fill empty secondary care rotas.
The ageing population and workforce crisis in general practice means that the profession is now facing a perfect storm.
The Government needs to pay attention to this and start looking at more short-term and long-term solutions that will actually work. We need a much more comprehensive long-term strategy, which would have been available if we had been given sight of the GP Taskforce recommendations, which have not been published despite being submitted at the beginning of the year.
Questions have to be asked about why this delay has occurred. Dr Krishna Kasaraneni is chair of the GPC GP trainees subcommittee.
PATIENTS RISK BECOMING ‘BEREFT OF A GP SERVICE’
From the News Desk of Jeanne Hambleton
Source Pulse Today
Posted 25 June 2014 | By Sofia Lind
The chair of the GPC has warned that patients are at risk of becoming ‘bereft of a GP service’ in some areas – prompting the Department of Health to accuse GPs of ‘scaremongering’.
Addressing the BMA’s annual representative meeting later today, Dr Nagpaul will say that general practice is ‘imploding’, and that continuous defunding of the service has caused a ‘tragic’ and ‘quadruple whammy’ of a crisis in workload, workforce, premises and morale.
He will say that general practice is seeing 40 million more patients annually than five years ago, the greatest rise in any sector of the NHS, that its share of the NHS budget has dwindled from more than 10% to less than 8%, and there was a 15% reduction in GP training applications last year.
But the DH has said it is ‘scaremongering’ to claim general practice is imploding.
Dr Nagpaul will tell delegates today: ‘These intolerable pressures have butchered the joy and ability of GPs to care for their patients, leading younger doctors to shun general practice in favour of a career in hospital, with a 15% reduction in GP training applications last year, and 451 places unfilled.
Ministers ignore this workforce crisis at their peril, which seriously risks leaving patients bereft of a GP service in some areas.
‘And whilst the government has announced £650m to ease winter NHS pressures, can you blame GPs for feeling aggrieved that the crisis affecting 90% of patient contacts in the NHS which is in general practice is given zilch, showing a callous disregard for the plight of a profession on its knees.’
The solution, he will say, is to ensure GP services are funded by just over £70 per patient, which he describes as a ‘bargain’ compared to hospital services.
He will say: ‘Therefore, amidst all the headline-grabbing pressures in the NHS, I urge ministers to open their eyes and wake up to the fact that general practice is not just in crisis, it’s imploding. And if the building blocks of the NHS crumble, the NHS collapses too. Not alarmist, not scaremongering. Just fact.
‘I call upon government to finally stop denigrating GPs as the problem, and to see us as the solution. That in an NHS paralysed with cash constraints, it’s logical to invest in the unarguable cost-effectiveness of general practice. GPs are a bargain at the price – just over £70 per patient per year pays for unlimited appointments, home visits, telephone advice, and so forth – a fraction of the tariff cost of a single outpatient appointment.’
But a DH spokesperson said: ‘It is scaremongering to say that GP services are “imploding”. The number of GPs has gone up by 1,000 since 2010 and we’ve taken tough decisions to protect the NHS budget so we can strengthen family doctoring, reform out-of-hospital care and improve GP access for 7.5 million people.
‘GPs agreed to be at the heart of our radical plans for more personalised community care in return for cutting their targets by more than a third to free up more time with patients. GP premises must be fit to help deliver a single, seamless service for the elderly and most vulnerable.’
‘GENERAL PRACTICE IS IMPLODING’
‘General practice is not just in crisis; it is imploding’
From the News Desk of Jeanne Hambleton
Posted 25 June 2014 |
Read Dr Chaand Nagpaul’s will tell the BMA’s annual representatives meeting that it is ‘tragic’ that general practice has been systematically devalued, attacked and defunded. Read the speech in full here.
I stand before you for the very first time as chair of the BMA’s GP committee, proud to represent 46,000 dedicated GPs working tirelessly across the UK.
Today nearly a million patients will visit their GP surgery – put into perspective that’s 16 times more than those who’ll attend accident and emergency – UK general practice is truly the pulse and lifeblood of the NHS, and that which keeps it alive.
It is admired globally, independently evaluated as having highest levels of quality personalised care, cost effectiveness, and equity. We provide the totality of first point of contact services, unlike parts of Europe where GPs for example don’t see maternity, gynaecological conditions or children.
UK GPs manage demand with 19 out 20 patient contacts concluded in primary care itself.
Whilst this should be cause for celebration, it is tragic that within our own shores, NHS general practice has been systematically devalued, attacked and defunded, leaving it in a parlous state, with the quadruple whammy of a crisis in workload, workforce, premises and morale.
We are seeing record numbers of patients in general practice – 40 million more annually than five years ago, the greatest rise in any sector of the NHS, set to increase relentlessly with a growing older population, and tranches of care moving out of hospital.
Yet despite this escalating workload, we have seen brutal disinvestment, with general practice’s share of the NHS budget dwindling in a decade from above 10% to now less than eight, and a real terms reduction of £450m in 3 years, and now MPIG and PMS funding cuts which threaten the viability of many GP surgeries nationally.
We have similarly seen a relative reduction in the GP workforce, with the number of GPs as a proportion of all doctors in England reducing from 34% to 26% in two decades.
The simple fact is that demand has far outstripped our impoverished capacity, denying patients the care and access they deserve.
GPs are struggling to square an impossible circle to manage the multiple complex physical and mental health needs of patients in the barebones of a 10 minute consultation- an insensitive insult to so many of our most ill patients.
We are forced into providing conveyor belt care at breakneck speed, up to 60 times in a day, added to by an open-ended volume of phone calls, home visits, repeat prescriptions, results, reports and hospital correspondence.
This is unmanageable, exhausting and unsustainable and puts safety and quality at risk.
It is therefore no surprise that even a Government commissioned report last year showed GPs suffering record levels of stress, and a BMA survey showing that 6 out of 10 GPs intend retiring early.
These intolerable pressures have butchered the joy and ability of GPs to care for their patients, leading younger doctors to shun general practice in favour of a career in hospital, with a 15% reduction in GP training applications last year, and 451 places unfilled.
Ministers ignore this workforce crisis at their peril which seriously risks leaving patients bereft of a GP service in some areas.
Nor do we have the space to care. With no dedicated funding for GP premises in over a decade, were struggling to provide 21st-century care from dated buildings designed for a past era, without the rooms for GPs to consult, patients to wait or staff to work in.
And whilst the government has announced £650m to ease winter NHS pressures, can you blame GPs for feeling aggrieved that the crisis affecting 90 % of patient contacts in the NHS which is in general practice is given zilch, showing a callous disregard for the plight of a profession on its knees.
Therefore amidst all the headline grabbing pressures in the NHS, I urge Ministers to open their eyes and wake up to the fact that general practice is not just in crisis, it’s imploding. And if the building blocks of the NHS crumble, the NHS collapses too. Not alarmist, not scaremongering. Just fact.
There are 340m consultations in general practice annually compared to 21m in A&E – itself under pressure. The fact is that if you destabilise general practice, it would only take us to see 6% fewer patients to double the numbers attending casualty if they went there instead, with drastic consequences.
Therefore I call upon Government to finally stop denigrating GPs as the problem, and to see us as the solution.
That in an NHS paralysed with cash constraints, it is logical to invest in the unarguable cost effectiveness of general practice. GPs are a bargain at the price – just over £70 per patient per year pays for unlimited appointments, home visits, telephone advice, and so forth – a fraction of the tariff cost of a single outpatient appointment.
And that is why we have launched our campaign ‘Your GP cares’, calling for more GPs, nurses, staff and buildings. To provide us with more time and tools to care for patients, which would reduce hospital pressures, improve the nation’s health, and release cost efficiencies in a cash strapped NHS – we would all gain from this investment.
RB, in conclusion, I urge you to support us in our fight for the very survival of UK general practice and in doing so for the survival of the NHS itself.
Talk soon. Jeanne