Detailed plans must address ‘looming crisis' in general practice

9 March 2016

The Public Accounts Committee calls for a detailed review of general practice in England, warning problems with recruitment and retention mean there are not enough GPs to meet demand.

The Committee finds the demand for general practice grew faster than capacity throughout the last decade.

It concludes good access to GPs is too dependent on where patients live and that "patients who are older, white or in a more affluent urban area get better access than anyone else".

It is also concerned that, in cases where people do not have easy access to information about general practice, "they may go to A&E instead or do nothing at all".

NHS England "appear to have been complacent"

In summary, the Committee finds the Department of Health and NHS England "appear to have been complacent about general practice's ability to cope with the increase in demand caused by rising public expectations and the needs of an ageing population, many of whom have multiple health conditions".

On staffing levels, the Report highlights concerns that more GPs are leaving the profession, particularly older staff with more experience; it is too difficult for GPs who have left to return to practice; and NHS England and Health Education England are struggling to attract new doctors to become GPs.

It urges government bodies to report back to the Committee by December 2016 setting out, among other measures, how they plan to reduce the number of GPs leaving the profession early; how they plan to attract more GPs to return to practice; and to establish which incentives work best in attracting new recruits.

Chair's comment

Meg Hillier, Chair of the PAC, said:

"There is a looming crisis in general practice. For too long staffing levels have failed to keep pace with the growth in demand and too little has been done to close the gap.
Experienced GPs are quitting while training places go unfilled; there are alarming variations in the experience of different groups of patients, and in some cases even basic information is hard to find—piling additional pressure on other parts of the health service.
These are serious problems requiring serious solutions. Government accepts action is necessary but we must have confidence this action will result in the best possible outcome for taxpayers.
For that reason our Committee has set out a series of measures we expect Government to act and report on by the end of this year.
NHS patients are entitled to expect fair and equal treatment and we will be holding government to account to ensure the concerns identified by our Report are being addressed."

Report summary

Most of the contact that people have with the NHS is with their general practice. Good access to appointments in general practice is important not only for patients' health but also to reduce pressure on other parts of the NHS.

Generally patients have a positive experience of getting and booking appointments, and they trust and value their GP. However, patients' ability to get an appointment, and to get one with the doctor they want, has gradually but consistently declined in recent years, and the proportion of patients reporting problems in accessing general practice has increased.

There is also significant variation in the experience of different groups of patients and between different practices. Younger people, those from minority ethnic groups and those in deprived areas are less likely to be able to book an appointment.

Staffing has not kept pace with demand

In recent years the Department of Health (the Department) and NHS England have failed to ensure that staffing in general practice has kept pace with growing demand. They appear to have been complacent about general practice's ability to cope with the increase in demand caused by rising public expectations and the needs of an ageing population, many of whom have multiple health conditions.

The Department and NHS England now seem to recognise the urgent need for action and they envisage significant changes in general practice over the next few years. NHS England has committed to increasing funding for general practice and is seeking to increase the number of GPs, to make more use of technology, and to support the creation of more federations of practices and multi-disciplinary large practices.

To help general practice to change, NHS England needs to do more to identify and evaluate what works, and to ensure that best practice is applied more widely.

Further information

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