“The Doctor will see you now’”…but in the future? Maybe not

Written by Tony Millett.

The general election brings - as usual - a wealth of promises and opinions about the NHS.  There is not, however, much talk about the GP crisis.  

About ten per cent of NHS doctors (not all of them GPs) are EU nationals - so unless the post-Brexit status of EU nationals to remain is not fixed soon, the shortage of GPs could get a lot worse.  A poll in February found that nearly two out of three EU doctors in the NHS were considering leaving the UK.

As it is, our GPs are part of the ageing population.  The Wiltshire Sustainability and Transformation Plan (STP) area - made up of Wiltshire, Swindon and Bath & North East Somerset - has been named as one of eleven STPs with a serious number of GPs close to retirement.

A document seen by the Health Service Journal lists STP areas rated 'red' for having too many GPs at or near retirement age.  In the STP area that includes Wiltshire 19.3 per cent of its GPs are over 55.  For seven of those STP areas the figure is over 20 per cent.

That data is quite old - it was collected in September 2015.   More recent national data from December 2016 shows that across the NHS in England the percentage of GPs at or near retirement has risen since 2015.   

In the real world, away from party manifestos, an average of two GP practices are closing every week in England. They are mainly smaller practices.

In the careful words of a report for the Wiltshire Clinical Commissioning Group's board meeting (May 23): "In common with many other CCG areas, Wiltshire GP practices are beginning to face challenges with respect to sustainability of delivery of primary care services and resilience for the future."

The latest figures (January 2017) for Wiltshire show that the county is short - in terms of 'whole time equivalent' posts - of 9.8 GPs, 7.9 nurses and clinical staff and 16.3 admin staff.  

Twenty practices in the county are trying to recruit GPs and twelve practices are currently classed as 'vulnerable'. For surgeries, the board was told, workforce issues are a "major cause of vulnerability" and "vulnerability is a big threat to the future" of the county's primary care service.

It is not just retiring GPs that raise the risk level.  Last year it was found that 64 per cent of Wiltshire's practice nurses are over 50 years old.

After three GPs left suddenly, Warminster's Smallbrook practice is in a three month period of 'emergency measures' opening only three days a week.  It will stay active until the end of August and then...

In Wiltshire three practice mergers (including Pewsey-Marlborough) are underway - with a further six practices considering their options.  Merging practices, board members were told, is 'very hard work'.  

Though Dr Anna Collings of the nearly fully merged Kennet and Avon Partnership (formerly Marlborough and Pewsey's separate practices) emphasised that they had found strong support and goodwill among patients to help make the merger work.

The quality of GP provision in Wiltshire is high.  Following CQC inspections of 51 Wiltshire practices, seven are rated 'excellent', 39 as 'good' - with five 'requiring improvement'.

Wiltshire Clinical Commissioning Group is taking over the commissioning and funding of primary care, which includes the GP service, from NHS England.  And they have produced a new 'risk register' for the implementation of their part of the national plans for the GP service.  The highest of six risks states:

"Larger number of GP practices becoming vulnerable more quickly than expected....Loss of clinicians through retirement, sickness and resignation and inability to recruit replacement staff.  Practices affected by increases in demand from rapidly growing local populations."  

It may be that recruiting more GPs is not the only answer to the crisis.  As the report to the board puts it: "To support new models of care there needs to be a step change in the flexibility and adaptability of GP practice staff, working differently, working across organisational boundaries and becoming more flexible in their approach."  

Which is raising the topic of introducing Nurse Practitioners and more Health Care Assistants. And that, in turn, it was pointed out, means educating people that may be they cannot always see their GP and their condition can be treated by someone else in the practice - a fully trained health care professional, but not a GP.

The GP crisis has finally roused the Department of Health into some action. Various pots of money are being handed out to help with the shortages and for developing the GP service in England.  This includes £15 million for CCG's to 'fund online GP consultation software'.  So face-to-face appointments may get rarer still.  

There was much discussion at the board meeting as to why Wiltshire found it so hard to recruit medical professionals - especially GPs.  A Lay Member of the board, Peter Lucas, asked: "Do we really feel we are doing enough to recruit GPs?  We are not getting the message across that this is a jolly nice place to live and work."

However it was also argued that "We need to find a way to make the job [of a GP] meaningful and satisfying."   To which Dr Toby Davies from the CCG's southern area, responded: "They used to come to Wiltshire - but the way the job has developed has put them off."

In Wiltshire between March 2016 and January 2017 2,520 people were added to GP's lists.  While Wiltshire Council hurries forward its house building plans, someone has to pick up the pieces - pieces of important infrastructure like the GP service that seem so often fall of spending plans.