There was a recent report released by the Health Foundation comparing the experiences of GPs in high-income countries. Unsurprisingly, it revealed that, quite frankly, things aren’t that great.

It was a report that highlighted that those who are in a position to make positive changes seem disconnected from the issues. They don’t seem to appreciate the urgency of what needs to happen, or even what it is that needs to happen.

I posted a tweet from my personal twitter account (@miken231) expressing my concerns, and a prominent GP quite rightly asked me, “What would you suggest?”

My response to this question was quite simple:

General practice needs to become a safer, more attractive and supported place to be for clinicians, the non-clinical workforce and, in turn, our patients.

How to achieve this is trickier though!

Personally, I feel we’ve reached a stage where we almost need a full reset. Therefore, it’s fortunate that a completely new contract is due next year.

When the NHS started in 1948 there was one clear and unified voice that described how and what the service should provide. People were even given an information leaflet about it! My family practice, where my granddad, gran and great-aunt all worked as GPs at that time, were a part of this change.

Like most things that evolve, the NHS has become an extremely complex beast where people seem to be making decisions based on political agendas; however, it’s patient care that should be at the heart of the decision-making process.

Many bright and experienced people have been involved in making recommendations over the years. Some have provided evidence to the Health and Social Care Select Committee regarding “the future of general practice”, and the King’s Fund report before that.

I believe the current message of “no money” just isn’t acceptable. The main areas of focus need to be:

• Retention of workforce (both clinical and non-clinical): Clinicians have already, and quite rightly, been discussed, but there’s also an exodus of support staff and extremely experienced practice managers, all leaving the profession due to excessive workloads and stress.
• Estates: There has been too much focus on, and investment in (comparatively), hospitals instead of GP estates, and this has been an ongoing issue. Although they’re a vital part of the team, the exponential increase in the clinicians’ part of the ARRS has decimated most practices. For example, I regularly have to move from my office because a clinician needs to use it for a telephone consultation. But I simply can’t perform all my duties and meetings without a room!
• A strategic rethinking of how we spend money in healthcare in this country: Far too much money is spent on reactive medicine, and not on preventative. This is not only highlighted by the percentage of the health budget that’s being spent in primary care compared to secondary care, but also in the contractual tick-box targets that general practice is focused on. The government has always underestimated just how much work #teamgp does (exemplified by the 2004 contract), but even as recently as the imposition of the latest contract – with its focus on access and immediate gratification – it seems that healthcare is being directed more by news outlets and negative smear campaigns than the voice of the medical profession.
• Political experience: In most developed countries, especially in Europe, the lead healthcare politician is either a clinician or someone who at least has first-hand experience of working in the sector.

There are many people in the “med Twitter” community who have been tweeting all sorts of worrying data. We’re already seeing practices close, partners hand back contracts (roughly 20% of partners are considering doing so based on the imposed contract alone), and a sharp rise in newly qualified GPs moving abroad (which isn’t surprising when other environments offer half the work for double the pay).

I’m the third generation in my family to be a partner in the family practice. I’ve grown up appreciating the importance of continuity of care, but I’ve also seen how general practice has changed over the years – and not for the better. This is exemplified by a very personal loss: my dad, a practising GP for over 30 years in our family practice, died at the age of 62 while still practising as a GP in 2014.

There is no support for the NHS and general practice. #teamgp is teetering dangerously on the edge. And, as we know, when we fall, the NHS will collapse.

We need help. Not in ten years’ time. Now!

Mike Neville, Managing Partner and Regional Representative for the IGPM