Primary care: workforce pressures

Helen Stokes-Lampard writes about sustaining and improving quality in general practice in the light of increased pressures on the primary care workforce over the last decade.

Blog post

Published: 19/12/2017

Improving quality in general practice has always been at the heart of the RCGP’s mission – ‘to encourage, foster and maintain the highest possible standards in general medical practice...’

In February, the College’s governing Council passed an updated position statement on quality.

For us, quality general practice includes acting in ways that show compassion, providing truly patient-centred care and using evidence-based tools to constantly improve the treatment we can offer our patients.

Increased workload for GPs

But workload in general practice has increased 16% over the last seven years whilst investment in our service has declined over the last decade, and our workforce has not risen at pace.

With this in mind, it’s testament to the hard work and dedication of GPs and our teams that despite the intense resource and workforce pressures facing our profession, QualityWatch figures show the percentage of patients who said their overall experience of their GP surgery was good has increased from 84.8% in 2014/15 to 85.2% in 2015/2016.

Our profession is also playing its part promoting public (and global) health initiatives. Since 2004 the percentage of the population successfully immunised against influenza has stayed above 71%, and the UK prescribes fewer antibiotics than many other countries including Greece, Australia, and France.

It’s a credit the entire health and social care system in England that since 2009 over 50% of patients have consistently answered ‘yes, definitely’ or ‘yes, to some extent’ when asked if they had received enough support from local services or organisations to help manage their long-term conditions over the last six months.

From these figures, it is clear that we are all trying our best, in incredibly difficult circumstances to deliver the care and services our patients need - and our patients understand that.

Staff wellbeing

But this must not come at the cost of the health of healthcare professionals - that is counter-productive for everyone involved.

In fact, figures from QualityWatch show that the public sector – which includes healthcare - has been losing some of the highest number of working days a year to stress, anxiety and depression in the last decade.

Although this has declined since 2006/7 (0.91), numbers from 2014/15 are still much higher than other sectors with a loss of 0.63 days.

We know this is affecting GPs; the NHS GP health service, launched earlier this year as part of NHS England’s GP Forward View, and which offers mental health services for GPs, including those suffering from stress or burnout, already has over 900 GPs on its books.

Furthermore, research by the College has also shown that GPs are routinely working 11-hour days in clinic, and making up to 60 patient contacts a day.

This simply isn’t safe for us or our patients – and it certainly isn’t conducive to high-quality patient care.

Increased investment to come

In England, NHS England’s GP Forward View has been hailed a lifeline for our profession by the College.

Amongst other pledges, it promises £2.4bn extra a year for general practice, 5,000 full-time equivalent additional GPs by 2020, and 5,000 additional members of the wider practice team.

We need this huge set of promises delivered in full, as a matter of urgency – and we also need equivalent promises received and delivered in Scotland, Wales and Northern Ireland. The College is working hard to secure them.

Appropriate funding for general practice not only means we can provide the high-quality care that our patients need and deserve, but also the care we want to give.

Person-centred and coordinated care

Our position statement also talks about ‘providing person-centred and coordinated care, understanding the interaction between physical, psychological and social issues and working closely with key partners, such as the extended Primary Care Team, and the voluntary, community and social care sectors.'

This was the theme of my inaugural speech as Chair at the College’s Annual Conference in October, when I spoke about Enid – a recently widowed, 84-year-old lady, who was starting to make a lot more appointments than she did when her husband Brian was alive.

Although Enid has hypertension, type 2 diabetes, and flares of osteoarthritis in her hip, these aren’t the reasons she is coming to see the GP more often – Enid’s main problem isn’t medical, Enid’s lonely.

I spoke about how important it is to give GPs the time and resources to deliver the holistic, person-centred care Enid needs, taking into account the physical, psychological and social factors potentially affecting her health – ‘Enid-shaped care’. I am not suggesting that GPs should be counsellors or can cure loneliness, but when we identify anything that is adversely impacting on our patients’ health we need to be able to refer them onto the right source of help. This level of care takes time and we need the tools to deliver personalised care to all our patients.

The RCGP is calling on all four governments of the UK for the time, resources and freedom to do what is right for our patients – so that we can deliver quality, tailored care to Enid, and to all our patients who need it.