General practice today
General practice is working hard to deliver for the communities it serves.
But it is doing so against a backdrop of extreme pressure. Challenges around funding will be well known to the people in this room. Not to mention the constraints around the recruitment of GPs.
Meanwhile, multiple public health crises are driving demand at a daunting rate.
It’s not only the number of patients in need of care, but also the complexity of that care; an ageing population, the growing prominence of multiple morbidities and chronic conditions, a vast and unmet mental health need, and the deterioration of patients’ health as they await operations and their increasing need for care while they wait.
Everyone here today will be familiar with the complexity of the caseload and the strain it’s placing on an already fragile system.
In short, general practice is creaking under the weight of an unsustainable demand for care and that workload is taking its toll.
Our data show that, in 2023, nearly half of all GPs were struggling. That’s a higher proportion than any other doctor group.
They’re also the least likely to be satisfied with their jobs.
In fact, since 2019, GPs have consistently reported poorer experiences, across multiple measures including high risk of burnout, than other doctors.
When doctors’ wellbeing is compromised, so, too, is their ability to deliver great care. GPs are working hard to insulate patients from the ill effects of a strained system. But it’s painfully clear, to public and profession alike, that general practice is not on a sustainable footing.
Seeking solutions
Something – or perhaps many things – have to change.
More of the same just means more of the same – overburdened doctors who can’t give their patients the care they need and deserve.
We have to confront this challenge. Doing so requires fresh thinking, and a recognition both of what is required, and what is feasible, in the world we currently inhabit.
Government ambitions to expand medical school places are necessary and, of course, welcome. But turning those medical students into fully fledged GPs is a long-term endeavour. And that’s before you even consider the constraints on capacity – in the availability both of trainers and training places.
In a complex system that involves so many players, and one that is so critical to people’s daily lives, there can be no easy answers. But, if we think differently, there is potential to be unlocked.
A changing workforce
The healthcare workforce as we know it is changing – and is already vastly different from the one I entered in 1981 (which was male dominated and very top down).
Nearly half the medical workforce is now female and in 2022 more than 50% of the doctors who joined our register were non-UK graduates. In general practice specifically, the number of non-UK graduates in training grew by 86%. Data we’ll be publishing shortly shows a continuation of this trend into last year too.
This is driving an evolution in the sorts of roles doctors undertake overall. Locally employed (LE) doctors, among whom non-UK graduates are heavily represented, are now the fastest growing group. Doctors choosing to step off the training pathway after their second foundation year are also contributing to the growth in the LE cohort.
Beyond this evolving picture in our own profession, there is also change on the horizon that holds promise for patient care.
The multi-disciplinary team (MDT) continues to develop, and next month, Physician Associates (PAs) and Anaesthesia Associates (AAs) will come under GMC regulation.
As I am sure you are aware, PAs and AAs have been part of the workforce for around 20 years. But they have not been subject to regulation as other health professionals are.
The government has now corrected this, passing legislation that will make the GMC regulator from 13 December.
This is a vital development. Bringing PAs and AAs into regulation will provide crucial safeguards, including quality assurance around their pre-qualification education and the setting of professional standards. It will reassure the public that those treating them are appropriately qualified and will be held accountable for their actions. And it will help support the development of these professions, which are already playing a crucial role in meeting modern health needs.
PAs and AAs are not doctors and they cannot replace them. What they can do, though, is complement doctors’ skills by working alongside them, freeing up doctors to do what only they can do.As you’ll all know from primary care, not every problem in that setting requires the depth of knowledge and experience of a GP. And deploying GPs to deal with these more protocol driven or follow up issues means funnelling their vital skills away from those who really need them.
Many of the problems besetting general practice are thorny, with roots that will take a long time to unpick. But balancing the skills mix in primary care teams is something that is within reach. And with the right oversight and planning, it could make a real difference on the ground.
I am acutely aware of the debate around PAs, particularly in primary care. About their training, their deployment and, according to the RCGP’s recent vote, whether they have any role to play in general practice at all.
Resistance to the evolution of the MDT is not new. In fact, it’s something I saw up close as President of the Royal College of Ophthalmologists. As in general practice, the demand for care in ophthalmology far outweighs the ability to serve it, and patients were going blind because of delays in the system. And, as in general practice, part of the solution was drawing on the skills of the wider workforce to increase capacity.
In that case, we sought to upskill non-doctor colleagues by developing a common competency framework. Opposition from my fellow doctors was fierce. But in the face of an ageing population, with little chance of demand abating, patient-centred solutions had to be the priority. Wishing on the magic doctor tree was not the answer.
The line between civility and toxicity
It is right that we interrogate how the provision of care is developing. Healthcare is an evolving picture and we, as doctors, are in a strong position to shape and influence change.
The workforce is in flux, patient need is growing and expectations on all sides are changing.
Within this context, scrutiny and challenge – done in good faith – play a vital role.
But when that scrutiny descends into destructive discourse and social media scapegoating, the line between civility and toxicity has been crossed.
We all know that the health service rises or falls on the strength of its workforce – made up of many interdependent teams. Appreciation of – and respect for – the role that each colleague plays is fundamental to success. Not to mention the fact it makes for a much more pleasant working environment, and one more conducive to mental wellbeing.
I was disturbed to learn that nearly 65% of PA and AA students have been subjected to negative comments during placements, largely from doctors.
Reports of name-calling and belittling behaviour are unacceptable from anybody working in healthcare. The denigration of others cannot be permitted under the guise of “patient safety”. Compassion and courtesy are the duty of all doctors, as they are of all members of the multidisciplinary team. Because safe care is dependent on supportive, open and respectful working environments.
Change is hard and sometimes uncomfortable. But it is no excuse for dispensing with the basic principles of decency. Civility is not a nice-to-have. It is central to good patient outcomes.
Conclusion
We all want the best for our colleagues, and we all want the best for our patients.
Determining how to meet demand in a system under strain is a vital and challenging task.
It requires open discussion, constructive engagement and honest assessments.
And, always as our first priority, a commitment to a standard of care we can be proud of.
Today, I have shared data and research that are aimed to stimulate and assist that difficult discussion – alongside the essential and beneficial changes that regulation will bring to improve patient safety.
Source:- GMC UK
Link:- https://www.gmc-uk.org/news/news-archive/regulation-and-the-changing-workforce
