From a GP’s perspective, How do we retain and train GPs in the UK?
The NHS is going through a very tough time at the moment. Whether because of the controversial contract for junior doctors or the equally contentious decision to abolish nursing bursaries, its struggles are never far from the headlines. Every sector appears to be having its own very real problems, and General Practice is unfortunately no exception.
With this in mind, when we recently conducted a poll of GPs, we expected to see the dissatisfaction in the results. But when we asked “would you consider leaving the UK to practice as a GP abroad?” we were amazed at just how many people voted in favour of leaving; by the end of polling the ‘Yes’ camp totalled more than 90% of the votes. One comment we received was typical of the general feeling: “It has been very stressful working here as GP with work load increasing, high patient expectation and demands and constant pressure from government introducing changes apparently better for patients but not appreciating our hard work. There is so much work with less reward and no respect at all for this profession.”
What’s perhaps even more alarming is that this dissent isn’t just limited to current GPs; it appears to be taking effect on the future of the profession too. The number of applicants for GP training courses continues to drop each year, and now the numbers are falling pretty far behind government targets. This could cause a major problem if it continues for much longer.
So what can be done to rectify this? Well, some GPs have already started to react against the problems raised by policy. ResilientGP was created to offer support, as well as one-day courses, to GPs who may be at risk of burnout or other negative effects of the workload. “We are attempting to do what we can to regain autonomy and some positive outcomes in General Practice” says Dr Michelle Sinclair, who is one of ResilientGP’s founding members. “When we started ResilientGP we were warned it would be a self-fulfilling prophecy; that is if we drew too much attention to the downsides of General Practice, then no-one would want to become a part of this as it would already have a negative perception. But something had to be done!”
It’s not about coughs and colds
Having taken such a proactive approach to the issues facing General Practice, we were really interested to hear what her views – which we found thoroughly insightful and informative. What does Dr Sinclair think needs to be done to get more junior doctors to train as GPs? A major issue appears to be the perception of GPs to others in the medical profession: “In medical training, there’s a bad attitude towards GPs overall – they’re seen by many as second-rate doctors. Many of them think it’s just about coughs and colds. This is certainly not true, and has changed even more in recent years as practice nurses take on a lot of the less serious complaints”, she says.
I’ve done training with junior doctors who’ve just come off of a placement with us, and it’s been brilliant as it’s really changed how they’ve viewed it. If placements stayed for six months at a time, we could make an ever better impression! There needs to be more mandatory work with us; there’s even been talk of creating a hospital-based generalist as many hospital doctors are specialising in one very specific area. So to show these doctors that taking GP jobs is a good and respectable career move can only be a good thing.”
But of course, even more urgent is the dissatisfaction of current GPs – which the doctors at ResilientGP are seeing and hearing on a daily basis. What needs to happen to reverse this? Dr Sinclair’s immediate answer is that “Morale needs to be improved.” Adding to this, she says, “we always need to reward quality – any employer should aim for this. But we also need to ensure GPs are supported with the emotional side of their work. You get about 7 minutes (after a minute walking up to meet the patient and two minutes doing the data entry) in which to react and respond to whatever is thrown at you. For example if a parent comes in and isn’t sure how to cope since their 5-year-old died of flu, it’s perhaps not surprising that not everyone is able to find a coping mechanism for that.”
Bureaucracy and funding
Yet ‘red tape’ is also an issue; “We need to reduce bureaucracy. There are so many different bodies and it’s not always helpful. The CQC has been a nightmare for General Practice. A vast amount of effort, time and money goes into setting it up – but we have little to no notice of their arrival, and aren’t well informed or even briefed on how it will work.” This seems especially dispiriting when you consider that funding in General Practice – to spend on treatments – has dropped continually in the 18 years that Dr Sinclair has been a GP. “The difference is now significant” she says. ““General Practice needs a significant injection of cash. It now works out that there’s just £136 per patient per year on average. Some regions have a little more; my own is lower than this. The funding needs to change so that it follows the patient around and isn’t absorbed elsewhere in the bureaucracy. Frankly it’s not sustainable as it is.”
Naturally funding presents its own set of challenges – so does this apply to salary too? “There will always be top earners in any business, and they’re not on the breadline but the average GP's salary is lower than you’d think. It’s the same with junior doctors, and if their new contract is finalised it will cause further problems. You have to remember these doctors were the top 5% of their academic year, and the salary they could command elsewhere is far higher. If pay packets do not reflect this, well then it follows that overall employee figures will decrease.”
These issues seem clear enough to identify, but obviously they are far harder to change. Is there anything that can be done in the shorter term to help improve the situation for GPs? Dr Sinclair thinks so. “Ideally there would be a public information campaign that would show General Practice is a finite resource, and encourage people to perhaps make more use of their pharmacist,” she says. “And we need to look at demand. This 7/7 idea needs to be dropped, as at the moment we’re struggling to do 5/7. A seven-day service already exists; it’s called Out Of Hours. If we did provide full hours like Tesco, then people would still naturally expect this to be funded, and there’s no money coming in for it.”
But there’s hopefully a positive outcome on the way, as at least public perception has started to change for the better, to recognise the vital work our GPs do; “there have been more positive stories about us (or at least fewer negative ones) recently. It seems as though the media are finally considering what would happen if we were to disappear.”
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