Written evidence submitted by Dr Peter Ewing MRCGP, Senior Partner, The Red Practice, Crieff (FGP0028)

 

What are the main barriers to accessing general practice and how can these be tackled?

The main barrier to access is that there are not enough GPs.

Retention is a significant part of this, as acknowledged by Mr Hunt.

There is a common saying in general practice: ‘GPs don’t strike – they leave.’

The GP workforce crisis has been evolving over many years and has sometimes been aggravated by government policies and unhelpful interventions by other parties.

I tabulate my opinion (as a front line NHS GP) on the problems, effects and possible solutions below.

 

Problem

Effect

Possible solution

Annual Allowance pension tax

Generates unpredictable and unaffordable tax bills on money that has yet to be received and therefore has to be paid through loans. Working longer to pay the tax bill just increases the problem for next year. It therefore compels GPs to reduce their hours.

Modify tax regime to avoid excessively penalising GPs who work longer hours

Reduction of personal tax allowance if earnings >£100K

A regressive ‘tax cliff’ that results in marginal tax rate of 60%. (a higher rate than that paid by the extremely rich). Compels GPs to reduce their hours.

Modify tax regime to avoid excessively penalising GPs who work longer hours

Lifetime allowance pension tax

Effective tax rate of 55% on pension above LTA (a higher rate than that paid by the extremely rich). Compels GPs to retire early and/or reduce hours.

Modify tax regime to avoid excessively penalising working longer hours or to normal retirement age

Regulatory culture e.g. Bawa Garba GMC case

Profession lose trust in their regulator. Loss of morale and increased burnout. Wasting NHS resources through over-investigation and defensive practice. When errors occur in a health care system that is catastrophically overloaded, doctors fear that they will be blamed personally for a system failure. Suicides of several doctors facing GMC investigation, as mentioned in several coroners reports.

 

Ensure that GMC take full account of system pressures and unacceptably high workloads which inevitably make errors more likely. Doctors must not be the scapegoat for an overloaded healthcare system.

 

Repeated unfulfilled promises of additional GPs

Causes the profession to lose confidence in the government’s competence, especially when the root causes of the GP workforce crisis described here remain unaddressed. Consequent adverse effect on morale.

Stop making promises you can’t keep. Consult frontline GPs on the causes of the GP workforce crisis and address them.

Financial risks of being a GP partner, in particular unlimited liability with premises ownership or commercial leases, and risks of redundancy payments if practice folds through an inability to recruit.

Acts as a potent disincentive to becoming a partner. This results in increased costs to the NHS: I believe in Scotland, practices run by the health board cost 2.5 to 4 times as much as partner-run practices, and give lower continuity and patient satisfaction scores.

Amend legislation to allow practice partnerships to be limited liability partnerships. Give practical support to practices at risk of folding due to an inability to recruit. Transfer risks from commercial leases and redundancy liabilities to the primary care organisation, allowing GPs to focus on patient care. This is supposed to be happening in the Scottish GP contract but implementation has been slow in my region.

Inaccurate ‘GP bashing’ by the media and some politicians

During the pandemic first wave, unimmunised, often older GPs staffed the ‘hot hubs’ seeing patient after patient with suspected covid. At this stage of the pandemic I personally am working 14 hour days. I do not expect a medal, but neither do I think we should be accused of ‘hiding’. Although there is no evidence for it, there is a perception in the profession that the GP-bashing media articles were a deliberate attempt to transfer blame to GPs. The adverse effect on morale and retention is obvious.

Refrain from inaccurate criticism and blaming of GPs.

Constant and repeated changes to the pension scheme and pension tax. Over recent years there have been repeated  changes to LTA thresholds, retirement age, the way inflation is calculated, annual allowance and the scheme itself. These have mostly been deleterious to GPs.

Loss of morale and incentivises early retirement. Pensions are a half-century investment. When pension changes are made so regularly and frequently, the workforce lose confidence and are incentivised to retire early before they suffer another loss.

I believe in some countries pensions can only be changed with a ten year notice period. Alternatively, government should understand that repeated tinkering with a half-century long investment will affect retention.

Excessive workload

This is both a cause and an effect of the recruitment and retention crisis and therefore extremely difficult to mitigate in the short term.

Consider demand modification campaigns (aimed at both discouraging going to the GP with trivia and encouraging those with red flag symptoms to attend). In the short term, consider an equivalent of the ‘tax-free bounty’ given to military reservists to incentivise new entrants/returners or to incentivise later retirement or working extra days

 

Nov 2021