1 in 20 GP’s have closed down since 2012 [1] and in 2016 alone 58 practices closed down with 34 more closing down due to merging of practices.

So why is this? Reasons for this crisis include:

Too little resources

There has been increased demand for primary care but the percentage of the NHS budget spent on general practice has decreased from 11% in 2006 to less than 8.5% at the moment [1], in fact,

in 2014/15, the percentage was 7.94% (the lowest in 10 years) [2] and this will only decrease further in the next three years further forcing GP’s to close. Despite this, the government are asking for more; with an aim to move hospital care into the community without supplying the resources for this to be made possible.

Greater patient demand

Many sources say that it us due to the population growing older, for example, those with multiple long term conditions is set to rise to 2.9 million in 2018 from 1.9 million in 2008 as the likelihood of having a long term condition increases with age. By 2034, it is projected that those over 85 will account for 5% of the population which is 2.5 times more than it would have been in 2009 [2]. I feel like the NHS has been very slow in its response to the growth of the older population; it hasn’t happened all at once- those born in the baby boom are getting older, that is expected but even now there doesn’t seem to any infrastructure change to accommodate; it feels like any money spent is being poured into a black hole because the structure has not changed with the demographic and population changes.

73% of GP’s said that they were somewhat or very dissatisfied with their time spent per patient which was the highest dissatisfaction rate in the 11 countries researched [2].

Many GP’s work full time but many have portfolio careers in which they take up other responsibilities like ‘roles in clinical commissioning groups (CCGs); management tasks in their own practice or in a wider federation; other clinical work such as minor surgery, pain clinics or out-of-hours services; and roles in medical education and academia’. The data in [2] shows that part-time working in general practice has been wrongly attributed to feminisation in the workforce as both sexes across all age groups (with 49% planning to have a portfolio career 10 years into their career compared to just 18% one year into their career). Although more women work part-time, over their careers, this gap between men and women closes and the most popular reason for shorter working hours was not ‘family commitment’ but ‘intensity of the working day’; the reasons are more complex than just women wanting to shorten their hours to look after their family’s [2]. This hasn’t stopped women in the NHS being the scapegoat of the government and some media outlets.

The government would like to be open 12 hours a day and seven days a week to keep up with this demand but there aren’t enough resources or enough GP’s. We need more GP’s, but of course, because of all of the stress, graduates are being put off becoming a GP; the job no longer has the benefits it used to have of being a nice nine to five, respected job- the governments demands are stretching hours and are definitely disrespectful of the citizens doing their best to keep the core source of medical expertise running. Also, even with the promises to open 5,000 new GP’s by 2020, it takes a long time- ten years to train GP and the doctors are needed before any of these changes can be made. The slower growth of general practitioners is illustrated by how between 2010 and 2014, there was a 4.9% rise in the number of GP’s compared to a 13% rise in consultants in other specialities [2].

The shortage of GP’s will only increase as the older generation retire and the younger generation are being deterred. For example, the between 2005 and 2014, the amount of GP’s between the ages of 55 and 64 leaving the profession doubled [2]. In 2014, 15.5% of 55-59 year olds left and 17.9% of 60-64 year olds left but from 2009-2014, it was those under 50 whom made up 45.5% of those that left general practice. Only a quarter were over 60; this is not an issue of retirement, it’s an issue of the younger generation of GP’s leaving- what can be done to keep them interested? Definitely not increasing their hours shown by how more GP’s want to be salaried workers or locum workers instead of in partnership due to three hours, decreased salary, future uncertainty and reducing benefits if the increased pressure.

Another layer to this patient demand is the increased demand of those over eighty-five compared to the number of trained GP’s- in 2014, there was less than 0.0290 GP’s per an individual over 85 compared to 0.03025 in 2010 [2].

It’s not just the stress and increased hours that is putting off the younger generation but for the increased demand, the total expenses for GP’s have increased as gross income has fallen and therefore, the income for GP’s is at the lowest it has been since 2002/3 (this was based off of data from 2013/4) [2].

Bureaucracy.

The NHS is well known for its form-filling and box-ticking aspects that are ‘unnecessarily burdensome’ and is a problem because it distracts staff from patient care especially when the data collected doesn’t add any value. I think that if there was a standardised system of information so that the national bodies, trusts and local bodies could all get the information they required by using the same system instead of requesting information repeatedly in different formats it would save time. I personally don’t think that bureaucracy is the reason for GP’s closing down on its own, but on top of all of the other demands it just takes away more time.

So what are the government doing to help? I don’t know, it isn’t being covered by the media and everything about the NHS is being reported these days, every article just states the record closures, hopefully a plan will be put forward soon because instead of building 5,000 new ones, the government could stop the current ones from closing and open fewer.

Tell me what you think about the GP issue in the comments! Thanks for reading.

[1]https://www.theguardian.com/healthcare-network/2017/apr/08/general-practice-fails-nhs-fails

[2]https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Understanding-GP-pressures-Kings-Fund-May-2016.pdf

[3]http://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/challenging-bureaucracy.pdf

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