When a story emerged recently of a single-handed GP who’d had to cancel pre-booked leave with her family because she wasn’t able to secure cover from a locum, it was a striking example of the impact of the lack of available GPs. It made it abundantly clear that the consequences of the current shortage extend far beyond waiting times and work pressures.

It was illuminating to dig into this issue on our latest Practice Index Practice Manager podcast. It became evident that dealing with this challenge isn’t really an operational challenge (i.e., how we organise our rotas and secure locums) because however well we do that, we’re unlikely to always be able to avoid this scenario if we’re a small practice running with a limited number of GPs.

Linked to this issue, of course, is the impact it has on the attractiveness (or otherwise) of partnership. If I’m the business owner (partner) and I can’t secure cover for my leave, I’ll most likely cancel my leave. If I’m a salaried employee, I’ll probably take my leave, because securing cover is ultimately the problem of the accountable officers of the business (the partners) and not mine. So, when I’m deciding whether or not to become a partner, if I can foresee that I may not be able to take leave when I want to, then I may be far less likely to take the step into partnership.

The solutions required – given that finding more GPs is one that has clearly failed over the last six years – are more strategic than operational. The first place to start is to consider the skill mix of the practice. Can the way the work is organised be restructured so that rather than everything defaulting to a GP, the multi-professional team is led by a GP with much of the work being carried out by a range of other clinicians such as pharmacists, physiotherapists, physician associates and paramedics. We can build much more resilience into the GPs we have if we’re actively taking work off them, and enabling them to focus on the leadership, supervision and more complex clinical roles that only they can undertake.

But we still need GPs and, ultimately, we may have to decide that the critical mass of GPs required is more than we currently have, or can afford, or can attract. We’ve seen a big decrease in the number of single-handed and small practices in recent years, and this trend seems set to continue for this very reason. Merging into a larger practice may be the way forward.

During Covid, the idea of ‘buddy’ practices developed from its traditional position as a mainly hypothetical disaster-recovery arrangement, to one where practices were more actively supporting each other. It could be that in order to preserve the independent status of individual practices, some PCNs will further develop this idea of buddy practices so that it extends to things like covering the leave of GPs across practices.

An even more radical solution is articulated in the Fuller Report. This talks about creating a single system of managing on-the-day demand across practices in a PCN area. This may end up with smaller sites (practices) not seeing any on-the-day demand and instead concentrating solely on providing the continuity of care required by specific cohorts of the population. This would represent a fundamental shift in the model of general practice, but is one that many currently overwhelmed practices could find extremely attractive.

So, the solutions to the shortage of GPs are primarily strategic, and cover skill mix, scale, partnerships and even models of care. The challenge for practices is finding the time to think strategically in the face of such operational pressure.

Click below to listen to this month’s episode.