Are you in despair for your future in General Practice?

Interim Results of Survey for GPs and Practice Managers across England

Originally published on 29 July 2014. Copied from BBOLMC.co.uk on 14 August 2014.

Aim

The purpose of this survey is to highlight an imminent crisis in General Practice. It is intended to provide information for policy makers to ensure that General Practice, the backbone of the NHS, is sustainable in the short, medium and long term. It is not about making the case for increasing pay for GPs

Introduction

In 2013, my practice advertised in the British Medical Journal, on two occasions, for a salaried GP with a view to partnership. This recruitment process resulted in only one credible candidate. At the time my surgery constructed a narrative to explain our failure to recruit. During the year and early in 2014 we spoke with other surgeries in Oxfordshire and realised that we were not alone in being unable to recruit.

In April 2014 we ran a Survey Monkey questionnaire across GP practices in Oxfordshire. We received 167 replies in the space of a few days. This convinced us that there was a serious situation developing that could affect the future of General Practice. At the end of June 2014, at the request of a group of concerned GPs from North and North-East Oxfordshire the survey was amended to include additional questions in order to assess whether the perception of a developing crisis in General Practice was real and, if so, to provide evidence to policy makers to address the developing crisis as a matter of urgency. The questionnaire was circulated as widely as possible.

The survey appeared to touch a nerve in general practice. It was first circulated on 30 June 2014 and as of today 24th July2014 had received over 2750 responses from across England, with the majority of responses from GPs including partners, salaried, sessional and locums.

The results are unmistakable. General Practice is facing an imminent crisis. Workload in General Practice is unsustainable. A significant number of GPs are ‘burnt-out’. This is leading to GPs taking early retirement, a career break or seriously considering emigration. Newly qualified doctors are not coming into General Practice in sufficient numbers. This crisis in recruitment and retention is increasing the pressure on those GPs that remain.

Results

The headline results of the survey are:

• 73% report that one or more GPs in their practice is suffering ‘burnout’ due to increasing and unsustainable pressure of work.
• 58% of GPs indicate that they will either retire or take a career break within the next five years with a mode age band of 45 – 54.
• 11% of GPs indicate that they intend to emigrate within the next five years with a mode age band of 35 – 44.
• 96% feel their practice is experiencing an ever-increasing and unsustainable workload
• 54% of respondents are not confident their practice will exist in five years’ time.
• 19% of respondents are confident their practice will exist in 10 years’ time.
• 66% of GPs indicate that, in the event of the devise the partnership model of General Practice, they would be unwilling to work for a private provider will stop
• 72% feel that General Practice needs to attract more doctors willing and able to work fulltime.
• 50% feel that the partnership model of General Practice is becoming unsustainable for the future
• 56% report that it is not easy to recruit new GP partners whilst only 9% of respondents report that it is easy to recruit new GP partners.
• 48% report that it is not easy to recruit new salaried GPs whereas only 14% report that it is easy to recruit new salaried GPs.
• 51% report that it is not easy to recruit locum GPs whilst only 18% report that it is easy to recruit locum GPs.
• 64% feel that their referral rate is likely to increase in order to accommodate the increased workload from secondary care
• 42% would feel comfortable rejecting work from secondary and community care in the event of being unable to recruit sufficient doctors and practice nurses to replace those retiring. 40% report would feel uncomfortable with this proposition.
• 75% of respondents would support asking the Secretary of State to suspend contract management on the Avoidable Admissions Directed Enhanced Service.

In addition to the raw but compelling quantitative data obtained from the questionnaire, there is a significant amount of free text that has yet to be fully analysed. The penultimate question asking for respondents to identify issues not addressed by the questionnaire has yielded 26,000 words. Each response now needs to be analysed and themes assigned. Initial analysis identifies several recurrent themes. These include:

• Low morale due to constant denigration of General Practice by Government and the press.
• Unsustainable Workload
• Compromising of family relationships due to demands of General Practice
• Unrealistic expectations of population fuelled by Government and media.

Discussion

The results of the questionnaire are compelling. Assuming there are roughly 32000 GPs in England, this questionnaire has been answered by 8.5%. It is possible that the those responding were a selfselecting, disaffected cohort but we believe this is doubtful.

The results indicate a crisis in General Practice. There is a crisis in recruitment in that it appears that young doctors do not want to go into General Practice. There is a crisis in retention in that significant numbers of GPs in the age group 35 – 44 are now considering emigrating or leaving General Practice.

This could leave a demographic hole in General Practice that could last for a generation.

Furthermore those approaching the end of their career - the 55-60 age group - are looking to leave General Practice prematurely. A number of respondents report ‘looking for an escape strategy’.

There is a crisis of morale as those GPs that remain in General Practice struggle to cope with a patient population that is aging, with decreased mortality but increased morbidity in conditions such as coronary heart disease (Patient.co.uk, 2014). In addition these GPs are trying to cope with a workload that is expanding with the shift of work from Secondary to Primary Care as outlined in the Government

policy document “Transforming Primary Care”.

This questionnaire only sought to address the problems associated with General Practice. The crisis identified in General Practice however is also developing in other areas of primary care, specifically community nursing. It was beyond the scope of this investigation to investigate the issues with community nursing but it is believed these require urgent attention as well as General Practice.

Conclusions

The main conclusion to be drawn from the interim results of this questionnaire is that General Practice is facing a crisis and that this crisis, unless addressed urgently, will leave General Practice so depleted as to be unable to deliver the government’s strategy for primary care – shifting work from Secondary to Primary Care - as outlined in the Department of Health document “Transforming Primary Care”.

In survey, it was only been possible to identify what are the problems facing General Practice. It wasbeyond the scope of this questionnaire to identify the root causes of these problems and to offer solutions as to how these problems might be addressed.

This study has identified a crisis in General Practice. It is now a matter of urgency that the rootcauses of the crisis are identified and addressed. It is recommended that an independent commission into the state of not just General Practice but the whole of primary care, including community nursing, is established as a matter of urgency.

With specific reference to General Practice, the commission should investigate:

• Why young doctors are not entering general practice?
• Why mid-career and senior GPs are considering leaving general practice?
• What can be done to make general practice once more an attractive career for dedicated and talented doctors?

Andrew McHugh

Medical Practice Director & Principal Author

Horsefair Surgery, Banbury, Oxfordshire