Written evidence submitted by Dr Adrian Curtis (FGP0136)

I am an enthusiast for General Practice in the UK and the GP partnership model.  I have been a GP since 2007, after 11 years training in medical school and hospital posts.  I am a GP Partner, a GP trainer, a GP surgeon (GPwER) a GP Training Programme Director.  I am married to a GP and I have 3 young children.  My Dad was a GP for 30+ years before retirement. 

I am worried that General Practice is on a precipitous downward trajectory and I worry for the future.

GP Workforce:

Many of my older GP colleagues are looking at early retirement as a way out.  The 11-12 hour days are grinding them down.  And let’s not forget these are the super resilient generation of Doctors who have worked full time for most of their careers and survived long working weeks long before the protective EWTD. 

The current GP pension system and taxations on earnings are a great disincentive for experienced senior GPs working more or for longer.

New GPs are already worried about the state of their chosen profession.  They choose to work 3 day weeks to survive and protect themselves from the punishing days.  Some new GPs have already left the profession due to work stress (well evidenced – see average age for new GPs leaving the profession)

Government manifesto promise of 5,000 more GPs in given timeframe ??

The UK does not have enough GPs to cope with the demand.  We start work at 8am, arriving to a huge pile of results and letters which have accumulated.  We work non-stop for 11-12 hours and finish the day with more work than we started with.  Sadly, a lot of GPs are having to work from home until late and night, just to keep on top of the workload.  We are bright, motivated, super-efficient people who care about our patients.  However, we feel we can’t sustain this. 

Encouraging international medical graduates to join UK general practice training schemes is grossly unfair on the applicants.  We know they struggle with the exams (as per national differential attainment data and evidence), yet now allowance is made to give longer training schemes.  The visa system offered to international GP trainees and newly qualified GPs is discriminatory and unfair.  Hampering recruitment and retention. 

 

What can be done to reduce bureaucracy and burnout, and improve morale, in general practice?

We need to train more GPs to help share the load – if we continue with General Practice in its current model.  Alternatively, we could look to more of GP consultant model – like the hospital consultant model.  Where there is currently a 60+ week wait to see some consultants, following initial referral, in my local area.

We should be supported to work safely.  With a maximum number of patient contacts per day.  Currently there is no maximum and we work until the patients stop contacting the surgery on that day. 

Some protected working hours would help – as per the Consultants contract. 

Supporting General practice to lower patient demand and expectation would help.  There is nothing to stop every patient registered at a GP practice contacting that practice on a daily basis and requesting an appointment, regardless of clinical need.   

 

Partnership model in general practice

The partnership model is a great success and a great incentive for GP partners to run successful, well performing practices. It is the reason I put so much into my work and want the practice to succeed and consequently provide an excellent service to our patients.  If GPs were all salaried doctors, many of us would have left the profession a long time ago or would be seeking other work as well.  I would anticipate many more practices would have failed and be failing if there were no GP partners.  The partnership model is not for all GPs, but in it’s current form it gives the career option and choice. 

GP partners are well placed to help co-ordinate and facilitate effective use of integrated care systems and pathways, which may well be unique to their population demographics.

 

Current contracting and payment systems in general practice

Seems woefully inadequate.  The amount we receive per patient is too low. An individual patient could choose to make an appointment every week of the year.  Generate hours of administrative work for the GP and practice staff, and the annual payment would be the same.  Our Doctors and Nurses could be looking after many of their patients and getting paid less than the national minimum wage for the world class care they are providing. 

Why not have a tariff system of work done for patient = payment made.  As per hospital trusts and to a certain extent Dental practice.

For reference, we have a good idea how much solicitors, lawyers, private consultants are paid per hour.  Is a highly qualified and experienced GP’s time really ‘worth’ less than a tenth of this?

 

The development of Primary Care Networks

Has felt an absolute disaster and is adding to the destruction of UK general practice.

The administrative burden for our GPs and practice staff has been huge, to engage with and run / support the PCNs.  UK General practice did not need the creation of PCNs.  Many practices were already working together and sharing staff to provide a more integrated community care service. 

Many GPs and administrative staff have spent hundreds or thousands of precious cumulative hours work with the PCNs for no discernible improvement in patient care.  These work hours have been taken from already overstretched and understaffed practices, inevitably adding to pressure and burnout with General Practice.  

Most GP practices felt strongly coerced into joining PCNs, being advised by their CCGs that they would miss out on large funding streams if they didn’t join, and this would jeopardise their practices. 

Why do PCNs make different GP surgeries share staff?  It is a disaster on every level.  Retention is poor, efficiency is poor.  Patients have the perception that there are more barriers to accessing the level of care they would like.

PCNs seem to eroding the fundamental ethos of the General practice model.  Stifling GP practice creativity and inventiveness. 

General practice has always been able to work in effective partnerships with other professions within primary care and beyond.  We used to have effective and efficient working relationships with our community professions, especially when they were linked to individual practices.  The move to centralise community professions has eroded these effective partnerships.

 

Summary

The remit and timeframe have likely encouraged a summary of what is currently wrong the UK General Practice.  Rather than giving the time and scope to look for solutions from it’s burnt out, overworked, demoralised GP workforce.  I have only found the time to put these brief thoughts together by using my personal and family time. 

If we are to help UK General Practice thrive and be the vanguard of the NHS we need to listen to its dedicated GPs and give them some time and space to find solutions to the crisis in partnership with their patients and community colleagues. 

 

Dec 2021