Primary Care and GP Services

Definitions

Primary care: The first point of contact in the healthcare system. This includes general practice, pharmacies, dental and optometry.

Vacancy Rate: The percentage of unfilled jobs.

Foundation Year 1 (FY1): The first year of a qualified doctor after medical school.

Core GP Training: After the two foundation years, a doctor can choose to specialise. Core GP training is one of these courses which is three years long and qualifies you as a GP.

Flexible Pay Premia: Payments made to trainee doctors of certain specialities in order to encourage recruitment for that speciality.

Key Issues facing Primary Care

  • In 2018 over 15% of GP posts were vacant (vacancy rates in 2022: 9.7% NHS average, 3.7% UK average).

  • Since 2013 roughly 500 GP practices have closed down.

  • A 2022 BMJ survey found 1 in 3 GPs were planning on leaving the profession in the next 5 years.

  • 10% of GPs are seeing over 60 patients a day. The safe working limit is 25 patients.

  • Many GPs are averaging 11 hour days, 8 of which are for patient consultations.

  • A GP appointment is limited to 10 minutes, regardless of language barriers, severity of the diagnosis, necessary examinations etc. This is leading to diagnostic error (10-15% of all diagnoses are erroneous in primary care) and GP burnout.

  • GPs have one of the highest suicide rates among NHS workers.

  • GPs have one of the highest defence costs (all the costs of defending against a lawsuit).

  • Half of all patients who needed a GP appointment in 2022 avoided it due to difficulty booking one, worry of being a burden on NHS, fear of covid etc.

  • Each year more then 15 million GP appointments are missed. This is costing the NHS around £200m.

  • Due to difficulties of booking GP appointments, some individuals are going to A&E. This is increasing the strain on A&E and hospitals.

Solutions

These solutions can be divided into Public Education and Staffing:

Public Education

  • Educating patients when to see a GP and when a pharmacy can help them (e.g. pharmacies can treat conjunctivitis without a GP appointment).

  • Messaging patients a day before to remind them of their appointments.

Staffing

  • The 2019 NHS Long Term Plan has invested £4.5bn into primary and community care.

  • The “Golden Hello” is a £20,000 lump sum given to new full-time GPs in some areas.

  • £10m has been invested in methods of encouraging more FY1 doctors into Core GP Training (e.g Flexible Pay Premia and promotional videos).

  • Increased incentive for international recruitment (e.g the NHS Visa).

  • More telephone GP consultations. This increased from 10% in 2020 to 49% in 2022. These reduce commuting times, reduce delays and enable GPs to see more patients. However, they prohibit physical examinations and thus may lead to higher rates of diagnostic error.