Solving the crisis in general practice is crucial to make the NHS sustainable, two senior GPs warn today.

“If general practice fails, the whole NHS fails,” according to Sir Sam Everington and Professor Martin Roland, writing in The BMJ.

Their warning comes the day after an international survey found that British GPs are the most stressed in the rich world.

The pair warn that hospitals would be “overwhelmed” if GPs ceased to manage the majority of their patients without referral.

GPs get £136 annually for each patient – and this is less than the cost of a single visit to a hospital out-patient department, they say.

Sir Sam is chair of Tower Hamlets Clinical Commissioning Group, London, and Professor Roland is professor of health services research at Cambridge University.

They say the £2 billion deficit in the hospital sector is “dramatic” but someone “usually” picks up the bill. GPs in contrast balance their books with a declining share of the NHS budget.

But GPs are having trouble recruiting trainees and replacement partners, they say. And they warn of the impact of cuts in social care and a failure to keep NHS budgets in line with European neighbours.

The pair suggest a range of measures, including the slashing of the red tape linked to Care Quality Commission inspections by reducing the number of inspections.

And they call for new roles in general practice to take the “strain off” doctors, including physician associates, pharmacists and advanced practice nurses.

Sir Martin said: “GPs need to feel valued rather than continually criticised by politicians and regulators.

“Many other countries see primary care as the jewel in the crown of the NHS, yet many practices are at breaking point, with an increasing number simply handing in their contracts and closing.”

Sir Sam said: “Family medicine and new developments like social prescribing show the strengths of general practice in supporting vulnerable patients in all aspects of their physical and mental well-being.”