At the time you read this column it will be just over one month since the Health and Social Care Bill was passed by the House of Commons. It may be that the Queen has since added her signature and this badly thought-through piece of legislation has taken its place within the laws of our land, despite the collective opposition of most senior health colleges and organisations. Castigated by many for my early, publicly expressed opposition to the proposals, I am now metaphorically deafened by those who have awoken too late in the day to the reality of the destruction to the integrity of our National Health Service that this political axe now threatens.
However, we are where we are and, as with all previous NHS upheavals, those who are already tasked with providing the majority of the health care in this country will roll up their sleeves and try to make a silk purse out of a sow’s ear. I speak, of course, of the General Practitioners; those without whom the foundations of the NHS would simply crumble. I say that, not because I am a GP, but because it is a fact that 80% of health care is performed in General Practice. We are, in effect, the front line of the health service.
That said, it will probably come as no surprise to you if I say that the front line is under siege. The pressures on general practices around the country are already overwhelming, and the bad news is that it is about to get worse. If you have difficulty in getting an appointment to see your GP, thank the government for the mess they have created for us all. Not only are GPs already having to spend many more hours per week in running the health service (not forgetting that the Government shamelessly started to dismantle Primary Care Trusts even before the Bill was passed by Parliament), but a lack of investment in General Practice has left it in a perilous state, with smaller practices facing the potential prospect of closure, and larger practices having difficulty in recruiting new doctors as partners or associates. Even locum doctors are a fast disappearing commodity.
Across the country, an additional man-power crisis is looming. 10% of GPs are over the age of 60. In London, the figure rises to 38%, and in the West Midlands it is around 17%. Coupled with that, many GPs in their 50s are looking to an earlier retirement than previously planned; mainly as a direct result of the effect of Government policies on workload, reduction in primary care funding, excessive taxation and unwarranted meddling with pensions. However, recruitment to general practice has been flat since 2010 (running at a ‘growth’ of 0.2%). With the deepest of respect you, as patients, can complain all you like to our practice managers, and we as doctors can say ‘sorry’ as often as you can stand hearing it. However, without significant re-investment and the instigation of an immediate policy for creating more GPs, the situation is only going to go from bad to worse. As it is, general practice as you know and desire it to be is not presently sustainable for the longer term. In truth, the cynics amongst us wonder if that is really the Government’s ulterior motive. The Secretary of State for Health has now won his way; the question is at what future cost to the health of us all?
(First published in the Scunthorpe Telegraph, Thursday, 5th April 2012)