Improving access to GPs is now the clear priority for Londoners particularly as 90 per cent of all NHS patient contacts are in general practice. The Prime Minister recently floated the idea of seven day a week opening for GP practices only for the idea to be rightly torpedoed by the Royal College of GPs (RCGPs) simply asking, where the GPs are to provide this service?
The RCGP and the British Medical Association both say that GP practices are already overstretched and underinvested. The investment in General Practice is at a historic low of just over 8 per cent of the total NHS Budget with a fall of £400m in real terms over the three years to 2012-13. Whilst during the last five years the number of GP consultations gave gone up by almost 60m to 370m per year.
The RCGP estimates that 22 per cent of GPs in London could decide to “step back from frontline patient care” within the next 5 years. This comes on top of the number of unfilled GP posts quadrupling in the last three years. Add more work to an already understaffed system and you have the recipe for healthcare in the capital to go from seriously ill to critical.
Before becoming a London Assembly Member, I was a full-time frontline GP and I know that the workload is unmanageable. I still work as a GP a few days a week but can understand many throwing the towel and why others are not attracted to become GPs. Demand has grown for GP services; everyone has a story about the difficulty of getting on a GP list, or trying to get an appointment. At the same time only 62 per cent of GP training places were occupied last year and the number of GPs per 100,000 people in the UK has dropped from 70 to 66 over the last decade
The top down re-organisation of the NHS, which no one voted for, has pulled doctors out of the consulting rooms and into the boardroom meetings of Clinical Commissioning Groups. Doctors trained to look after patients and promote wellbeing but not to ration healthcare, fragment services or increase privatisation in the NHS.
The Government’s policy of putting out services out to the private sector has forced GPs to set up Limited Companies so that they can fight to keep services within their practices to protect their patients. No wonder doctors are asking themselves if they are in the right profession. In London this is resulting in an even more fragmented system; one which leaves the needs of patients secondary to the bureaucratic processes of distant and unelected Clinical Commissioning Groups.
Draconian welfare cuts and the imposition of the bedroom tax are but two more examples of policies which increase the strain. Increasingly GPs are taking on benefit appeals on behalf of their patients and pleading for exemptions from the bedroom tax. Rather than helping to reduce stress and improve services we have decisions driven by ideology and not reason. The result is to make life even more difficult for many who then need the help of their GPs.
In summary low recruitment, a reduction in funding, low morale, extra responsibilities and the largest patient load ever are having real effects on patient experience. All at a time when the population of London is set to rise by 1.2 million by 2020.
If we push the system any further London’s GP structure could collapse, especially in deprived areas where the demand and need for GPs is greatest. It is time to wake up and see the crisis in the NHS. Years of top down restructuring has resulted in a mess of a management structure that any self-respecting multi-national cooperation would scrap and sack those responsible. There has been no funding increase over the last five years, yet demand has gone up. The NHS hasn’t stood still under this government, it has actually gone backwards.
The problem isn’t just structural, it is capacity. That is why I welcome recent proposals to invest £2.5bn on 8,000 more GPs, 5,000 more caseworkers and 3,000 more midwives. This would be a start but we also need to get GPs back doing what they trained to do, that is why patients in London and beyond need to see the Health and Social Care Act repealed to reverse the chaotic mess putting so much strain on our NHS.
Dr Onkar Sahota AM is Labour London Assembly Member for Ealing and Hillingdon. Prior to this, he was a full-time GP