Are family GPs going extinct?


Family doctors and local GPs are a British institution, but according to the president of the Royal College of General Practitioners, such services could one day be a thing of the past.

Dr Maureen Baker was quoted by the BBC last weekend claiming that the General Practice as we know it is "under severe threat of extinction".

"It is imploding faster than people realise and patients are already bearing the brunt of the problem," Dr Baker alleged.

She pointed to the increasing number of surgeries that are having to close due to severe staff shortages.

Looking into government funding, Dr Baker argued that spending arrangements were disproportionately managed when GPs deal with 90% of all patient contact, but are only given 8.39% of the National Health Service's budget.

She also noted how inflation was causing a real-terms drop in the amount of money directed to GPs. While GPs were given a budget of £8.3 billion in 2009-2010, correcting for inflation that amount was worth £8.9 billion in 2012-2013's money.

The actual amount budgeted for GPs by the NHS in 2012-2013 was £8.5 billion, representing a real-terms drop of £400 million over the last four years.

In November the RCGP published figures showing by percentage of budget how much GP budgets had dropped between 2004 and 2005, and 2011 and 2012. In Scotland, GPs received 9.47% of the NHS budget in 2004-2005, and 7.78% in 2011-2012.

In Wales, GP budgets dropped from 8.58% of the NHS total in 2004-2005, to 7.77% in 2011-2012.

"For generations, GPs have been the bedrock of the NHS and provided excellent care for patients," Dr Baker said.

"But we can no longer guarantee a future for general practice as our patients know it, rely on it - and love it.

"GPs are doing all they can but we are being seriously crippled by a toxic mix of increasing workloads and ever-dwindling budgets, which is leaving patients waiting too long for an appointment and not receiving the time or attention they need and that GPs want to give them."

Criticising the notion that these cuts might be economically necessary, Dr Baker said: "Cutting funding to the bone is a false economy - by investing in general practice, we are shoring up the rest of the NHS from collapse."

"We are fiddling while Rome burns and the four governments of the UK must wake up to the critical state that general practice is now in."

However not all those who examine the situation are as concerned.

Professor Chris Ham, chief executive of the health think tank The King's Fund, said on the BBC that: "I'm not denying the real pressures and the lack of funding, but it's a massive leap from saying that to saying GPs face extinction."

He pointed to ways that various GP surgeries were looking to manage with less resources, including providing services by telephone and on the internet.

There have also been moves to widen the use of generic drugs in NHS prescriptions, and get better value for money out of existing IT systems rather than upgrading.

Dr Peter Saunders, Chief Executive of Christian Medical Fellowship, also disagreed with the extent of Dr Baker's concerns.

"I do not think that our GP service faces extinction," he said. 

However he does believe that the present system is coming under strain. 

"As a result of our ageing population, growing complexity of health problems and an increasing target-driven administrative burden in the face of growing financial pressure GPs are having to do more with less and are under tremendous pressure trying to meet the need."

Although he did not blame the government for causing this problem, Dr Saunders did suggest that it had been exacerbated by the falling share of the NHS budget for GPs. 

"CMF has over 2,000 GPs as members and there is no doubt that the work pressures they face have increased in recent years," he said. 

"The present high standard and level of care [a GP's surgery] provides will not be sustainable without new sources of funding and smarter patterns of working."

Speaking about the role of religious doctors in particular, Dr Saunders said: "Christian GPs have a unique opportunity to improve their patients' physical and spiritual health and to show the love and compassion of Christ to people who otherwise have no contact with the church at their point of need.

"In the face of these growing demands they need our prayer, understanding and support."

A survey conducted by the RCGP found that 62% of 1,007 people asked believed that the number of consultations GPs are expected to do daily - between 40 and 60 - represents a risk to the quality of patient care.

The survey also noted that 28% of people asked said that the last time they tried to book an appointment, they could not get one in the same week, while 40% were concerned that the waiting time for an appointment had negatively affected their health.

In terms of funding decisions, 60% of respondents wanted more funding redirected from other parts of the NHS to GPs' surgeries.

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