Huntingdonshire doctors reporting unmanageable pressures on general practice

“The relative share that the NHS spends on general practice has fallen from around about 10.5% down to 7.5% of the NHS budget, and that’s simply not sustainable.”

gp08:19 Friday 10th June 2016
BBC Radio Cambridgeshire

DOTTY MCLEOD: We were hearing earlier on from a GP in Huntingdon who says his workload at the moment is just getting impossible, family doctors in general in Huntingdonshire saying their workload has become almost unmanageable. The revelation came to light after the doctors’ union the British Medical Association published its latest results to its Heat Map survey. This map shows how GPs are coping with increased pressures, increased workloads, and it shows that doctors in Huntingdonshire have the highest workload in the county. Doctor Ian Sweetenham is a GP in Huntingdon.
IAN SWEETENHAM: I think unmanageable is a good word for it. We just have enormous amounts of work to do, and we don’t have the resources to cope with it. So I spend my days and my evenings just working. There’s too much paperwork, a large amount of regulation, the level of demand has gone up enormously. There’s something like another 40 million consultations done in general practice a year. That’s extra since 2008. We’re now at 340 million consultations every year. There are not the resources, there’s not the doctors, there’s not the investment. In fact the funding has been cut.
DOTTY MCLEOD: Well GPs in only one constituency in Cambridgeshire, North West Cambridgeshire, say their workload is manageable. All of the others said that it was often unmanageable, and Huntingdonshire says it was just unmanageable. We can speak to Dr Richard Vautrey who is the GP Committee Deputy Chair for the British Medical Association. Richard, are you surprised at these results from Cambridgeshire?
RICHARD VAUTREY: Not at all. They replicate the results from around the rest of the United Kingdom. The pressures on general practice are increasing dramatically, and yet the funding has not kept pace with that. And that’s also meant that practices don’t have the resources to not only appoint new GPs if there were any GPs, but also extend their practice staff to cope with patient demand.
DOTTY MCLEOD: So Huntingdonshire has the worst rating on this Heat Map. How many other areas are like that?
RICHARD VAUTREY: I couldn’t give you a specific number, but certainly it’s replicated in many other parts of the country, particularly where GP practices are struggling to recruit new GPs. That then adds extra pressure onto those doctors and nurses left within the practice, because we’re dealing with more and more patients with more complex problems. Many of the problems that were once dealt with in hospital are now being dealt with by GPs and their teams within their practices. And we simply haven’t got the capacity to meet that need, and that’s why many of your listeners will be struggling to get a GP appointment, because there simply isn’t enough time in the day and enough appointments available to meet their growing needs.
DOTTY MCLEOD: Is there a sense that the culture has changed, that more people are requesting GP appointments more often?
RICHARD VAUTREY: It’s partly because we’re living longer, which is a good thing. But we’re living with more complex problems, so people are not only living with diabetes, they may have heart disease, they may have lung disease, they may be frail and elderly. And where once they may have seen their GP two or three times a year, now they may be seeing their GP almost every month in some cases. And so we’re finding that we simply don’t have the capacity to meet the needs of those patients. And at the same time the relative share that the NHS spends on general practice has fallen from around about 10.5% down to 7.5% of the NHS budget, and that’s simply not sustainable. We have to reverse that. We have to significantly invest in general practice and build up community-based services, to meet the needs of our patients.
DOTTY MCLEOD: Well let’s get another view on this. Thank you Richard. Dr Richard Vautrey there who is the GP Committee Deputy Chair for the BMA. Listening to that is GP Dr Emma Tiffin, who works in a surgery in Cambridge, also a spokesperson for the Cambridgeshire and Peterborough Clinical Commissioning Group. That’s the body that’s responsible for NHS-funded health care in the county. Morning Emma.
EMMA TIFFIN: Good morning Dotty.
DOTTY MCLEOD: Do you recognise this situation that’s being described by Richard, that’s being described by Dr Ian Sweetenham in Huntingdonshire, where workloads for GPs are just unmanageable?

EMMA TIFFIN: Yes. I’m a practicing GP myself, so I’m in absolutely the same boat. There are two issues really. One is about a huge increase in demand, although some of that is due to people being more elderly. We also know that 40% of patients that see us as GPs could actually be managed at home. So there is something I think we can do around changing, reducing that demand. The other issue is about capacity. So the CCG has got a primary care development workforce group, and they are looking at what they can do to help support general practice. So there are ideas, what we would say were different models of general practice care, that we could adopt longer term if they work and take the pressure off GPs. So things like putting mental health expertise into practices, putting physio-expertise into practices, putting medicines management expertise into practices. They’re all chunks of work that take a lot of space out of my day that with a competent trained member of staff, so we’re not talking about a change in quality; we could actually support, release GP time, so that they can do more. I think the other issue that Ian raised was about IT and bureaucracy. Again we spend a lot of time Dotty chasing results from hospitals, chasing management plans, and again we need a much better system of communication between primary and secondary care. And the third issue is around recruitment and retention. How do we encourage GPs, how do we make people want to be GPs? We know that training places for GPs are empty, or not completely full. We know that people don’t .. it’s not an attractive job any more. And there are ideas that the CCG are looking at like what we call GP Fellowships. And I did one of these ten, twenty years ago, which is a sort of split role where it’s partly doing general practice, but partly doing a speciality, so that you develop a special interest. So mine is mental health, and that’s where I developed a lot of skills to enable me to support a lot of mental health patients in general practice. And that makes it more attractive.
DOTTY MCLEOD: Emma I completely take your point that the CCG is working on various plans at the moment to try and help GPs, to try and ease the workload. But could this not have been foreseen? because this has been rumbling under with warnings from GPs for years now.
EMMA TIFFIN: Yes. So the CCG doesn’t commission primary care Dotty of course so we’re helping support. That’s NHS England. But yes, I think workforce planning is another thing that the CCG is looking at. But actually as Ian said there’s been a reduction in investment over years, and we could forecast that. There’s been a reduction in GP numbers I think for a number of reasons actually. Also again that should have been forecast better. So workforce planning is something that I think traditionally the NHS hasn’t done very well, and it needs to get its act together Dotty. But again, the CCG are collecting data on what each practice has had, what they need at a very individual practice level, and that hasn’t been done properly before. So again that’s so that we know what we do need going forward. So it’s all about planning as you rightly say, and that needs to be much better.
DOTTY MCLEOD: Emma, thank you for your time. Dr Emma Tiffin there, who’s a GP working in Cambridge, also a spokesperson for the Cambridgeshire and Peterborough Clinical Commissioning Group.