The Care Quality Commission has announced that one in six GP surgeries could be putting 'tens of thousands of patients' at risk because of unsafe care. Levels of care are grouped into six bands, with 864 practices in the lowest band and 1,200 in the bottom two bands.
Does this mean your GP is definitely about to kill you if your practice is in a band one or two practice? No - while there is undoubtedly cause for concern with some of these practices, in others it's more a case of bad luck than bad judgement. As is so often the case with negative stories about GPs, there's more to this story than meets the eye.
Some of the indicators measure things which there's no excuse for GPs not to be doing. I agree wholeheartedly that practices have to a duty to:
- Pick up and record people who have heart disease so they can be followed up
- Limit prescribing of sleeping tablets, with all the risks they carry
- Prescribe the safest anti-inflammatory medicines (ibuprofen and naproxen) rather than others
- Avoid inappropriate prescribing of antibiotics, especially those linked with a higher risk of resistance or side effects such as Clostridium difficile
- Review patients at the end of their lives regularly
- Treat people identified as having osteoporosis with drugs to reduce the risk of further fractures
- Treat patients with atrial fibrillation with medicines that can effectively reduce their five-fold increased risk of stroke.
If GPs aren't carrying out these important roles, which make a huge difference to both quality of life and death rates, questions need to be asked.
But some practices are being penalised because, like many other GPs, they're struggling to recruit doctors and nurses. General Practice is in crisis - the relentless combination of ever-increasing bureaucracy, demands to save costs on prescriptions and referrals and negative media stories is taking its toll.
In 2004-5, 10.4% of the NHS budget went to general practice to provide services for patients. By 2011-12 that figure had fallen by almost a quarter, to 8.4%. That's £450 million less to provide more services and more consultations than ever. In England alone, there were 340 million GP consultations in 2013, up by 40 million since 2008. The people who are being seen are, on average, older and sicker, with far more health needs that just can't be dealt with in a 10-minute consultation. The government's solution is to impose more and more targets and bureaucratic demands on GPs, taking them away from face-to-face care of their patients to prove they're working 'efficiently'.
The number of people applying to become GPs has fallen by 15% in the last year alone; 40% of female GPs leave the profession by the age of 40; and six in 10 of the GPs who are working are considering retiring early because they can't cope with the pressure. In many parts of the country, it's getting harder and harder to recruit nurses, especially in areas where the cost of homes is high.
So it's hardly surprising that some practices are struggling to provide enough appointments; that patients can't get to see the GP they want to; that the practice can't find doctors to staff the practice for extended opening hours; or even that they don't have enough nursing time to carry out flu vaccines. Yet in my area, several practices have been highlighted as being 'at risk' because, while they're ticking all other the boxes, they fall down on these indicators.
And of course, none of the headlines related to the good news - the fact that for every practice in the 'highest concern' band, there were five in band six ('lowest concern') - in fact, half the practices in the country came out well in every one of the 38 indicators. Good news may be no news, but the never-ending barrage of bad publicity against GPs is only going to deepen the very real GP recruitment crisis. And if that happens and you think these findings are scary - you ain't seen nothing yet.
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