General practice is on the brink of crisis

Primary care provides 90 per cent of the consultations in the NHS yet only gets 8 per cent of the budget



Earlier this year I released a report titled ‘Access to GP care’ which focused on the looming crisis facing general practice in London. At the time I called it ‘the report which is ringing the warning bells’.

Last week the National Audit Office also began to the ring the warning bells and published their own work: ‘Stocktake of access to general practice in England’ on the issues of accessing general practice. The picture across England is that of a system on the brink.

Access to GP care is more than just getting the right appointment. Primary care is the backbone upon which the entire NHS is built. The vast majority of individual engagements with the NHS take place with our local GP surgery.

Difficulty accessing a GP has repercussions throughout the service. It can delay diagnosis, and thus delay timely treatment. Late diagnosis and treatments can lead to patient suffering and stress, and it is ultimately more expensive for the NHS.

Poor access to GPs can cause issues in other ways too. It can force patients to take different routes to access the NHS, commonly through A&E departments – adding to growing waiting times – all to get the consultation they should have received from their local doctor.

In recent years the number of consultations a GP performs has doubled but the number of GPs has not. This is completely unsustainable.

The number of GPs practicing is being pinched from the bottom and the top. Fewer students are choosing general practice as a profession. The extra unfunded responsibilities which are being passed to GPs and the poor quality of life compared to other health professions have left the NHS with a 12 per cent vacancy rate on the GP vocational training schemes. .

Meanwhile, for similar reasons, many GPs are choosing early retirement or to leave to take up a position overseas. The number of GPs applying for the certificate to practice abroad has shot up in recent years.  We are facing a workforce cliff edge, with 54 per cent of GPs over the age of 50 intending to quit direct patient care within five years.

It is no surprise to me or anyone in the profession that satisfaction rates with general practice are declining.

It is also shocking to read the detail of the inequality of access. Deprived areas tend to have lower ratios of GPs and nurses to patients. Those who are white found it easier to access a GP than those from BAME backgrounds, while 64 per cent of white patients who wanted continuity of care received it compared to only 47 per cent of black and 47 per cent of Asian patients.

There are complex reasons for these differences but none justify them: this inequality is utterly unacceptable in the 21st century.

There have been lots of discussions over the future of the NHS and what it will look like. All the analysis puts primary care at the centre of the future NHS. We can only make the NHS sustainable by taking patients out of expensive hospitals and treating them more personally at their local GP practices.

As more is demanded of general practice, the proportion of the NHS budget which goes to primary care has got  smaller. Primary care provides 90 per cent of the consultations in the NHS yet only gets 8 per cent of the budget. GPs are leaving, new entrants are declining to enter general practice and patients will undoubtedly suffer.

It is time the health secretary stopped squabbling with doctors and began to listening to them, because without the right investment in primary care and the staff who work in the NHS, the health service will continue to fail those who need it most.

Dr Onkar Sahota is a member of the Greater London Assembly for Ealing and Hillingdon, as well as a practicing GP in West London. He is chairman of the Assembly Health Committee

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