GPs are the most entitled ‘workers’ in Britain
General practitioners must surely be the most entitled members of the British workforce. In the face of the near total decay of their speciality, once considered the cornerstone of the NHS, they are now threatening to limit the number of patient-contacts to 25 per day. This definition of contact includes face-to-face and remote consultations – and even dealing with messages.
The dangers of remote consultations, especially for initial consultations, are now well recognised. Delays in diagnosis for serious conditions like cancer are among the consequences of excessive reliance on remote consultations, a problem that is worsened by the ongoing choice of some GPs to work remotely on a permanent basis, even “seeing” patients while abroad.
Seeing 25 patients per day face-to-face is reasonable, providing that a triage process has filtered out the trivia. GPs earn a huge salary, and we know from a Health Select Committee report published in 2022 that 58.4 per cent work three days or less. There are plenty of GPs, but sadly few of the working variety.
This is why patients have to wait sometimes weeks to see a GP, and even then, not the GP of their choice. This is also the reason why consultations are limited to 10 minutes each. Are doctors and the Royal College of GPs not ashamed of this?
Even more remarkably, Alan Millburn, likely to become a government advisor on health matters, has suggested that GPs should be central to the government’s plan to tackle joblessness. That might have been possible in the Blair/Brown era when he was last in office and when general practice was more effective, but the decline in efficiency since then is probably irreversible.
Governments have a habit of believing that improvements in health care must be “top-down” with extensive and expensive reorganisations. I suggest that the quickest way to improve healthcare and to impact joblessness, at least initially, is by “bottom-up” reform.
We need more doctors, especially British trained doctors who understand our culture. Wes Streeting, our new Secretary of State for Health and Social Care has promised 7,500 more doctors but they will not all be British trained. In 2023, we trained 8,301 doctors and imported 18,668 doctors from abroad. (2,887 from EEA and a staggering 15,781 International Medical Graduates mostly from India, Pakistan, Egypt and Nigeria). 50 per cent of GP trainees are now IMGs.
The NHS workforce plan published with great fanfare in June 2023 promised to double the number of medical school places to 15,000 by 2030/31. This is an impossible goal requiring at least 20 more medical schools. That’s without even considering the fact that we are losing British graduates in droves to work abroad.
In 2023, the GMC issued 8,661 “Certificates of Good Standing”, up from 5,576 in 2021. CGSs are essential for GMC-registered doctors applying to work in another jurisdiction in order to exclude fitness-to-practice concerns. This increase is truly alarming. We must retain our own doctors.
Patients who are seriously ill or chronically sick are probably better managed in hospital and not in general practice. There, investigations and greater skill are immediately available, with escalation to consultant opinion when necessary. Patients are already depending on A&E services for urgent care and therefore this service must be expanded to satisfy the need. Equally, we need more hospital beds.
In 1990, there were 300,000 beds in the NHS. In 2022/23 there were 103,000 acute beds. During this time, the UK population increased by 10 million. That’s why we have admission waits in A&E, why we have “delayed discharges” and why we had to spend a fortune on Nightingale wards during Covid.
So, while the great minds think up some “top-down” reforms, let’s quickly implement some from “bottom-up”.