Written evidence submitted by Dr Katherine Fallon (FGP0039)

 

I have been a GP partner at my surgery for 31 years. In that time of course the way we practice has changed hugely. We now take on a lot of the work which was traditionally done in a hospital setting. This is very satisfying and allows us to use our clinical skills to the full but of course takes up more time. We are now very good at managing very complex patients in the community with the help and support of our Consultant colleagues who we now have timely access to via platforms such as Cinapsis. Continuity of care however is vital to the management of these patients as they are so complex. There is evidence from Norway that shows that if a patient has been with their GP for over 15 years they have lower mortality, morbidity and usage of hospital services.

https://bjgp.org/content/early/2021/10/04/BJGP.2021.0340

The problem we have now is that young GPs do not seem to want to work in the traditional practice setting. We are a small practice with about 6500 patients. We have been without a 6 session salaried GP since May and have been unable to recruit. We practice just south of Bath in a lovely area so if we can’t recruit GPs I am sure it is much worse in other areas. We have had one expression of interest so far which came to nothing. We then expanded the advertisement to include remote working and immediately had three expressions of interest from three male GPs with great CVs. It seems young GPs just want to dip in and out of practice and not take on the continuity of care which is needed for good patient care. The reason I love my job is the great satisfaction which comes from the longitudinal relationships I have made over the years looking after four generations of some families but as a GP friend pointed out to me if the young GPs have never experienced this they do not know what they are missing.

I am 61 and it is unusual amongst my peers that I am still working but if I leave my two other partners now the practice will close. The PCN has enabled us to take on Clinical pharmacists who help but also need a lot of time consuming supervision. We have a Care Co-ordinator who is great and greatly enriches the lives of the patients we refer to her. We recruited a Physician’s Associate who only lasted a day when he saw the intensity of the work we do. As partners we have had to take on all the work of the absent salaried GP as locums are few and often only remote as explained above. We are now forced to apply for closure of our list as our retainer has now given in her notice for family reasons. We used to teach medical students for Bristol University but have had to stop that to concentrate on the core work.

I think the Partnership model works well as it retains GPs. As senior partner I am dispensing advice all the time to junior colleagues and it is vital to maintain that seniority and leadership within the profession. If there were only salaried GPs the NHS would have to employ even more GPs as partners all work many more hours. For example I am a six session GP and work at least a 40 hour week and am now working all day on alternate Saturdays giving flu and COVID boosters.

I am afraid I do not have any answers but I am clear that General Practice is a unique part of the NHS and valued highly by those patients who need to use it regularly. Although the other professionals we have working with us now helps reduce the burden a bit we just need more GPs and need to try and make General Practice more attractive. At present all young Doctors see is the relentless intensity of the work and the long hours.

When the hospitals are stretched as they are now that makes our problems worse as we are having to ‘hold’ patients while they are waiting for investigations/ surgery etc and so they take up even more of our time. The media seem to imply the hospitals are in trouble because people can’t get to see their GPs but if the hospitals were sorting out the patients on their lists then they wouldn’t have to keep coming back to us for blood tests, monitoring etc and then we would have time to see other patients.

It all snowballs. The ambulance teams are in crisis too and recently was the first time in 31 years I had to ‘queue’ to get a 999 ambulance.

I am sure there are lots of inefficiencies within the NHS as there are in any large organization but when I think of the procedures done now, the number of drugs available and the changes which have gone on since I started in general practice it is no surprise that the costs have gone up. This has to be recognized. We need more staff across the board and more hospital beds to accommodate our expanding aging population. The in turn will support general practice and allow it to continue and flourish.

If we loose General Practice we will not appreciate what we have lost until it is too late.

Thank you for reading this.

 

Dec 2021