General election NHS promises: my view as a GP
Election time is nearly upon us, and the political parties are all bigging up their promises - with health at the top of everyone's agenda. Given that 90 per cent of consultations in the NHS take place in general practice, it's hardly surprising that the politicians see easier access to GPs as a major vote-winner.
The Conservatives have promised that within five years, everyone will be 'able to see their GP between 8am and 8pm, seven days a week'. Labour's pledge, recycled from past Labour governments, is for guaranteed GP appointments within 48 hours.
But a new research article in the British Medical Journal looks at what will be needed to make these promises a reality and paints a very different picture. The first stumbling block is increasing the number of new GPs. It takes 10 years to train a GP, so any increase in GPs for 2020 is already five years behind schedule.
Then there are the GPs already working. GPs are already struggling with ever-heavier workloads which have forced many of them to breaking point. Nearly two thirds of GPs are considering retiring early, and 40% of female GPs quit the profession entirely by the age of 40. A report by the Department of Health within the last few months shows just how difficult it is proving to find replacements. GP vacancy rate had risen from 4.2 per cent in 2011 to 7.9 per cent in January 2013, and last year over 450 training places went unfilled because there weren't enough applicants. For the last four years, the government has had plans to recruit 3,250 new GP trainees a year - over that period alone, there has been a shortfall in recruitment of 2,200 potential new GPs. As a proportion of all doctors, the number of GPs has fallen to its lowest in 20 years - in 1995, 34 per cent of all UK doctors were GPs, while today that number is 26 per cent.
Of course doctors are better paid than people in many other walks of life, but they have much higher levels of responsibility and need to spend much of their own time keeping up-to-date with new advances. If junior doctors see other branches of the profession - or GPs in other countries - getting paid more for less demanding work, they are hardly going to jump at the chance to join. General practice has changed out of all recognition in the 25 years I've been practising, with patients being discharged from hospital earlier and earlier, and more and more of the work previously done in hospital being handed to GPs. A recent GP workload survey from Northern Ireland showed that in the last 10 years:
- Total numbers of consultations in GP surgeries increased by 63 per cent
- Number of repeat prescriptions issued increased by 42 per cent, as GPs look after sicker and sicker patients
- Number of test results dealt with by practices increased by 217 per cent, as GPs take on more investigations previously done in hospitals
- Administrative tasks increased by 115 per cent.
If we can't even recruit enough doctors for the current need, it's hard to see how the political parties are going to get enough GPs for the massive increase in availability they're promising. The Conservatives estimate they'll need an extra 5,000 GPs to make their 12 hour/7 day promise a reality; Labour say they'll need 8,000 more. If they try to implement longer working hours without more doctors, the ever-increasing trickle of doctors leaving general practice will become a flood - I foresee a domino effect, with the doctors left behind becoming more and more overwhelmed. But the biggest casualties will be patients who can't get the care they need at all.
I've never been fond of politicians of any persuasion. I certainly don't believe either Labour or Conservative when they make promises like this - and I would strongly suggest you don't, either.