Crisis fears for the future of GP practices in Lincolnshire

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The perilous state of GP practices across Lincolnshire has been highlighted in a new report which one patient group has described as ‘deeply alarming’.

The report, by the Lincolnshire Local Medical Committee, reveals a number of worrying statistics including:

• 40 GP vacancies in Lincolnshire are currently unfilled (11 per cent) compared with a national figure of eight per cent;

• The average GP-patient ratio in Lincolnshire is 1:1900 but in some practices it is as high as 1:2400. NHS England promotes a safe figure of 1:1750;

• With a doctor to patient ratio of 1:1750, there should be 415 full-time GPs in Lincolnshire but currently there are 340 – a shortfall of 75.

• 72 per cent of places for training new GPs in Lincolnshire are unfilled. The national figure is 12 per cent.

A member of one local Patient Participation Group said the report raised a raft of ‘worrying questions’ about the state of general practices in Lincolnshire.

He said: “It is deeply alarming. It is a crisis. People need to know just how bad things are. The figures speak for themselves.

“If you have tried getting an appointment at some practices, I think we know the system is under pressure but something needs to be done – and quickly – otherwise it is in danger of complete collapse.

“It is that bad.”

The report acknowledges that nationally, the number of registered doctors has increased by 12 per cent since 2010 with the number of speciality doctors rising by 22 per cent. However, it says the figure of new GPs in that time is only nine per cent.

The report points out that more doctors are also working part-time to combat work-related stress, or are increasingly having to work in ‘administrative roles’.

It says that as a result, the number of doctors working full-time since 2010 has actually increased by a smaller proportion.

The report also reveals that the current shortfall in doctors across Lincolnshire is partly made up by advanced nurse practitioners, nurse practitioners, practice nurses and paramedics.

The report goes on to paint a worrying picture for the future of general practices.

It says that nationally, 34 per cent of GPs plan to retire in the next five years and a further 17 per cent are planning to reduce their ‘clinical commitment’.

It adds that 40 per cent of GPs are currently aged 50 or over while 21 per cent of GPs in training are planning to emigrate after qualifying.

Those latter two figures, combined with the number of vacancies for new trainee GPs, has sparked fears of a shortage.

The report also focuses on funding, claiming there has actually been a year-on-year reduction in NHS funding in proportion to GDP (national income).

It says the level of NHS funding as a proportion of GDP is set to fall below seven per cent – below the average figure of nine per cent in other economically developed countries including France and Germany (11 per cent) and USA (16 per cent).

The report reveals the cost allocated by the NHS for caring for a patient to be cared for in general practice for a whole year is £136. It says that figure is the equivalent of 10 months’ pet insurance or six months’ mobile phone use.

For that £136, the report says, a GP practice will provide:

• As many consultations with a GP and a nurse as a patient needs;

• Prescriptions organised and signed;

• Blood tests;

• Referrals;

• Pre-hospital care;

• Post-hospital care;

• Home visits – if required.

It says that practices have to use the £136 to pay for premises, doctors, nurses and practice staff, utility bills, buy/maintain equipment and drugs, to be inspected by the Care Quality Commission (CQC), insurance and accountancy/legal fees. The report goes on to add it will be difficult to implement ‘new models’ of care – without additional funding.

It also raises concerns about several details contained in a top level NHS England report – published in April – called ‘General Practice Forward View.’

Some of the headlines in that report include proposals for:

• £2.4bn extra funding each year for general practice by 2020;

• 5,000 more GPs by 2020;

• 3,000 mental health workers and 1,500 pharmacists in general practice by 2020;

• £900m investment in practice buildings and IT over the next five years;

• new guidelines to reduce ‘inappropriate work’ being sent to general practices from hospitals.

However, the Lincolnshire Local Medical Committee report throws doubt on the viability of those proposals.

It says NHS England ‘promises a lot’ but there is ‘no detail’ of how those promises will actually be delivered including the extra funding.

There, says the report, are concerns funding could have to be diverted from other parts of the NHS.

The report also questions where the extra GPs will come from, stating junior doctors are choosing not to train as GPs – because of an ever-increasing workload.

It also questions where new mental health and pharmacists will come from, pointing out there is already a national shortage.

The report ends by calling on all Patient Participation Groups to lobby their MPs in a bid to:

• Encourage medical students and doctors to chose GP work as a career;

• reduce bureaucracy, especially from the CQC;

• increase total NHS funding to mirror the 11 per cent seen in other countries;

• increase funding to general practice to 11 per cent of the NHS budget;

• stop putting general practice under increased pressure by raising public expectation with ‘un-evidenced policies’ such as seven day working.

• We asked NHS England to comment on the Lincolnshire Local Medical Committee report but they had not replied by the time this story went to press.

Last October NHS England did issue a statement after concerns were raised about a shortage of GPs at some practices in the county.

At the time, Jim Heys, locality director for NHS England in Lincolnshire, said: “NHS England recognises the need for greater investment in primary care services, both in general practice and in wider community-based services.

“Overall investment in general practice in NHS England’s first year of operation, 2013/14, was £8.75 billion, up 3.5 per cent on 2012/13 and a 1.6 per cent increase in real terms.

“Our key priority is to ensure that patients have access to high quality GP services.

“We are working with our partners on initiatives to help to support the recruitment of GPs in Lincolnshire.

“As part of this, NHS England has provided funding for the Local Medical Council to develop the ‘Marketing Lincolnshire General Practice’ initiative.

“The GP recruitment incentive package is designed to attract new GPs into the area.

“The scheme was introduced this summer and it is too early to understand what impact the scheme will have on recruitment locally.”