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Where did all the doctors go?
Sensemaker audio

Where did all the doctors go?

Where did all the doctors go?

Lots of GPs are leaving the profession, and we can’t recruit or train new ones fast enough to fill the gaps.


Transcript
Nimo omer, narrating:

Hi, I’m Nimo and this is the Sensemaker. 

One story every day to make sense of the world.

Today… catchy pledges and broken promises: why the government is failing to recruit the GPs we need. 

***

Remember this?

“Thank you very much. Good afternoon. Well, wonderful to see everybody here today. Thank you all very much for coming. We’re now, as you know, less than 3 weeks away from the most critical election of modern memory…” 

Boris Johnson announcing the Conservative Party 2019 election manifesto 

The 2019 general election and Boris Johnson is making headline-grabbing pledges. 

One of them: the Tories would boost GP numbers in England by 6,000 by 2024. 

It’s a promise they cannot keep.   

“Jeremy Hunt: Is it your view that we are on track to meet that 6,000 additional full-time equivalent GPs by 2024? 
Sajid Javid: No, I do not think we are on track. No…”

Health and Social Care Committee, 2 Nov 2021

In fact, instead of going up… the number of GPs has actually fallen by 600 since that manifesto pledge.

And it’s not the first time the government has failed to meet its target. 

“The reason I ask the question is that the 6,000 target came after a target that I actually introduced in 2015 to have 5,000 more GPs by 2020, which we did not succeed in delivering…”

Jeremy Hunt speaking at Health and Social Care Committee, 2 Nov 2021

So why the problem with GP recruitment and retention? 

***

“My name is Dr Gary Howsam. I’m a GP in Peterborough and I’m Vice Chair of the Royal College of GPs, which is the membership organisation for GPs across the UK.”

Dr Gary Howsam

Dr Howsam is a GP – he’s been one for 13 years. 

It’s a great job: public health is important, the NHS is popular and GPs are well paid.

But that’s only part of the picture. 

“And I can honestly say that in the time I’ve been a GP, this is the busiest and the most relentless the workload has ever been. I still think it’s the best job in the world. I still feel incredibly privileged to be a GP, but it’s getting harder and harder to deliver the kind of high quality service I want to give to my patients just because of the workload pressures, which are made worse by the fact we are having massive workforce issues as well at the moment.”

Dr Gary Howsam

The pressure GPs feel might not be surprising given the stresses and strains of a global pandemic. 

But Dr Howsam is clear in his diagnosis…

“Well, the problems stem back a number of years, and it’s not all to do with the pandemic. I think the pandemic has shone a light…”

Dr Gary Howsam

GPs have long complained about their workload. The population is growing and ageing – and alongside the clinical issues are the business ones – the amount of time spent on paperwork and bureaucracy.

But all these issues are made worse by the biggest problem of all: the labour shortage. 

“And what we’re finding is that we’re losing a lot of younger GPs because the workload is just undoable. And we’re also finding that people are burning out and having to retire early or to reduce the number of days they work during the week, just in order to maintain their own health.”

Dr Gary Howsam

What he describes is a vicious cycle: burnt out and overworked GPs are quitting or retiring, in turn creating more burnt out and overworked GPs…

According to the British Medical Association – that’s the trade union for doctors – there are now just 0.45 fully qualified GPs per 1,000 patients in England. 

At a local level the picture is patchy: deprived areas fare the worst. 

According to a paper published by the Social Market Foundation, GPs in North Blackpool each cover 4,480 patients. In wealthier South Blackpool, the figure is 1,900.

Clearly, something needs to change.

And the government is prepared to splash the cash. But… not without conditions attached. 

“With a funding boost from the government signs of levelling up are now on show. They say access to GPs will improve and there will be an increase in face-to-face appointments. An extra £250 million will alleviate this national problem…”

Sky News clip

The extra £250m for GPs in England will go only to surgeries that meet targets for face-to-face appointments.  

The BMA has rejected the scheme and threatened strike action, arguing it just adds more pressure to the system and fails to deal with the underlying and long-term issues that plague the NHS. 

But it’s likely to be a move that’s popular with patients. More than half a million people signed a recent petition seeking to increase the availability of face-to-face appointments. 

So just how much work do GPs do?

The average GP now works just over a three-day week. That’s the lowest on record. Plus, GPs can earn really high salaries. At a minimum, a full-time GP will earn £60,000 but there’s no upper limit – and some earn in the high six figures. 

Those kinds of numbers might prompt the public to ask their doctors, “What’s your problem, exactly?”

But Dr Howsam argues they hide the real picture. 

“But the average GP is working over 40 odd hours a week. So it’s full-time work in less than five days, but people often comment, you know, you’re not working full time. You’re only part-timers – when the level of work and the intensity of work and the sort of decisions we’re making our life or death decisions.”

Dr Gary Howsam

***

So if things are as bad as he’s saying, what kind of future is there for GPs and their patients?

There is some hope. 

Take training. Admissions to medical schools are rising, almost doubling since the 2015-16 intake. 

However, it will take a long time to feel the benefits: training to become a GP takes around 10 years. 

And hanging on to doctors is a challenge. Dr Howsam points to a survey done by the Royal College of GPs, in which 35 per cent of respondents said they wanted to quit over the next 5 years. That would represent about 14,000 GPs leaving the NHS.  

It’s not all about overwork. The BMA has warned that changes to GPs’ pension taxation system in 2010 have had a knock on effect, with many GPs opting to retire early to avoid tax penalties. 

To them… it simply doesn’t pay to keep working. 

What’s needed are long-term solutions… but all too often it’s the problems we are experiencing now that dominate thinking. 

“It’s going to be a difficult winter. I mean, I’m sat in my surgery this morning. I’ve already spoken to about 30 people. I’ve seen about 10 people. There’s coughs and colds all around. It’s still very difficult to know whether it’s the flu, whether it’s the common cold, whether it’s Covid. Um, we still got nearly 5 million people sitting on hospital waiting lists that still need our care… So it’s going to be incredibly busy in general practice.”

Dr Gary Howsam

Which is why the issues around recruitment and retention need to be addressed.  

Because if they aren’t, the NHS will struggle… and today’s headlines will be repeated again and again.  

Today’s story was written by Claudia Williams and produced by Imy Harper.