The Challenges facing General Practice in East Cheshire
Politicians in denial
- Successive governments have failed to address the inexorably rising demand for free-at-the-point-of-delivery healthcare. Politicians continue to promise unlimited, 24-hour, personalised care but refuse to fund it adequately. The Government keeps promising the public a Bentley but funds a Robin Reliant and then blames everyone else when the very efficient Robin Reliant fails to meet hyped-up expectations.
No government has had the courage to have an honest discussion with the electorate regarding affordability or funding. Instead, successive governments have rationed healthcare by stealth as is the case increasingly in East Cheshire.
- Since the NHS was founded there has been a substantial demographic shift in the UK, with the number of people over the age of 65 significantly increasing. There are now over 11 million people over the age of 65 (by 2040 it is expected one in four people will be in this age range) and more than 1.5 million people are over 85. The number of people aged over 100 has risen by 72 per cent in the past decade.
- By 2021, more than one million people are predicted to be living with dementia and by 2030 three million people will be living with or have survived cancer. By 2035 there are expected to be an additional 550,000 cases of diabetes and 400,000 additional cases of heart disease in England. The number of people with multiple long-term conditions is set to grow from 1.9 to 2.9 million from 2008 to 20185.
- 18 million patients in the UK are estimated to suffer from a chronic condition, with the majority managed in the community by GPs. Around 53 per cent of all patients in England report having long standing health conditions, many of which will be treated at some stage by GPs.
- The increase in the proportion of older people will have a significant impact on health and social care services, which are intrinsically linked to GP services. Annual costs of health and social care, as well as the time and effort needed to provide effective care from GPs are significantly greater for older people and the number of elective and non-elective hospital admissions has also increased. It is predicted that the number of older people with care needs will rise by more than 60% over the next 20 years.
- As well as an older population, there is evidence that the patient population as a whole is getting more complex and suffering from a greater number of conditions that require increased time and resources to treat in the community. Since 1996, the number of people diagnosed with diabetes in the UK has more than doubled from 1.4 million to almost 3.5 million, while it is estimated that by 2050 obesity is predicted to affect 60% of adult men, 50% of adult women and 25% of children.
East Cheshire is affected by these demographic changes more than most other regions. As a result, it’s services are under more pressure and struggling more to cope.
Demand, workload and financial challenges facing general practice
- There has been an estimated 15 per cent increase in the number of GP appointments between 2011 and 2014 with at the last count around 340 million consultations undertaken every year in England.
- The average member of the public sees a GP six times a year; double the number of visits from a decade ago.
- In 2015, there were more than 600 GP trainee vacancies across the country, the largest ever shortfall in the number of young doctors joining the profession.
- In March 2017, the latest workforce figures showed a further decline of 100 GPs in the workforce despite government promises that GP numbers would rise by 5,000 between 2015-2020.
- Since 2008, GP income has declined by 11 per cent while there has, in the same period, been a 2.3 per cent rise in the cost of running a practice (including the amount spent on keeping GP practice buildings in good shape, energy bills for GP practices and the amount spent on GP staff, including practice nurses and receptionists). The cost of running a practice now accounts for 61.6 per cent of total GP income.
GP surgeries in East Cheshire are under immense pressure and are struggling to recruit doctors, nurses and administrative staff. Chronic under-funding due to unfair government funding allocations have resulted in some GPs leaving the NHS and emigrating to less pressured health care systems abroad. Waiting times to see GPs are rising for residents of East Cheshire and many have already noticed; this is only going to get worse.
Grassroots GPs: Pressures on the frontline
During late 2016, the BMA conducted a series of surveys of its members and GP practices aimed at painting a picture of the current pressures facing GPs on the frontline of patient care.
Key findings included:
- In 2016, more than 300 GP practices in England felt that they were under threat of closure because of the financial strain they were under.
- The same survey also found that around 40 per cent of GP practices had GPs planning to retire in the next five years and nine out of ten practices had to rely on locum cover to plug gaps in their workforce.
- A second survey of more than 5,000 GPs in December 2016 found that eight out of ten GPs (84 percent) believed workload pressures are either unmanageable (57 per cent) or excessive (27 per cent) and are having a direct impact on the quality and safety of the care they deliver to patients. Only one in ten (10 percent) describe their workload as manageable and allowing for good and safe quality of care.
- Almost a third of GP partners (31 per cent) also stated that they had been unable to fill vacancies in the last 12 months. A further one in five (18 per cent) said it takes between three and six months to recruit to a vacancy. Only one in eight GP partners (13 per cent) reported not needing to fill a gap in their workforce. Around a third of GP partners who need to hire locums do so in order to cover long term employment vacancies (31%) or to be able to continue to provide a full range of services (30 per cent) to their patients.
GP surgeries are underfunded and understaffed. In recent years, one GP surgery in East Cheshire, that has over 12,000 registered patients, has been funded for only 10,000 patients as its population of patients is deemed to be less deserving of funding than other more deprived areas in the UK. Whilst health inequalities need to be addressed, this cannot and should not be at the expense of hard-working tax-payers in East Cheshire. The missing funding would have paid for an extra four full-time GPs for this particular practice; four extra GPs that the government thinks East Cheshire doesn’t deserve.