Kings Fund Analysis into the Causes of GP Crisis Published

New research from The Kings Fund has revealed the extent of the crisis in general practice.

Their report, Understanding Pressures in General Practice, analyses 30 million patient contacts from 177 practices and includes extensive research with GP practices and trainees.

As well as a growth in the number of consultations, it shows that general practice’s workload has become more complex and intense. For example:

• There has been a 13 per cent growth in face-to-face consultations and a 63 per cent growth in telephone consultations, contributing to stressful and highly pressurised working days for GPs, despite other members of the team providing triage and managing minor illness.
• The overall number of consultations (face-to-face and telephone) has increased over the past five years at a rate three times that of the rate of increase in the number of GPs.
• The biggest increase in consultations were among the over-85 age group (up 28 per cent), who are more likely to have more than one chronic condition.
• The complexity of the cases being seen by GPs has increased, with many requiring more than a 10 minute appointment.
• The drive to move care out of the acute sector and back into the community hasn’t been adequately funded, putting additional pressure on existing resources in the community and therefore on GPs.

The report also underlines the scale of the recruitment and retention crisis facing the profession, finding that fewer GPs are choosing full-time clinical work. New research for the report found that five years after qualifying:

• only 1 in 10 new GP trainees plan to be working full time seeing patients in general practice.
• GPs are retiring earlier and in greater numbers: between 2009 and 2014, 46 per cent of GPs leaving the profession were under 50; between 2005 and 2014 the proportion of GPs aged between 55 and 64 leaving doubled.

The report argues that the Department of Health and NHS England have consistently failed to collect national-level data that could have anticipated the crisis that has now emerged. It says that general practice is at risk of falling apart unless significant additional investment is accompanied by new ways of working that build on current good practice.

As well as improvements to data collection and intelligence the report’s recommendations include:

• Placing general practice at the heart of new sustainability and transformation plans to ensure that the voice of general practice is heard and acted on.
• Developing new and innovative models of general practice (for example, multispecialty community providers) with a balance struck between the benefits of working at scale through federations and networks and making sure services are responsive to local people.
• Designing a workforce strategy through Health Education England that supports sustainable careers for GPs and their fellow team members, promoting sustainable and fulfilling options for development and recognising changing career preferences.

Beccy Baird, Fellow at The King’s Fund and lead author of the report, said:

‘While we have data almost in real time to tell us what’s going on in A&E, the only national-level data we have on activity in general practice is, at best, a year out of date. It wouldn’t be acceptable to try to run a hospital on out-of-date information and it shouldn’t be for general practice either.’

She added:

‘Investment alone won’t help the crisis in general practice. To avoid the service falling apart, practical support to do things differently is crucial and must be underpinned by an ongoing understanding of what is driving demand and activity. Only then will working in general practice be an attractive proposition and ensure the service remains at the heart of the NHS.’