GP services 'collapsing' and more funding needed, says Dr Welch

There are a vast array of issues facing the NHS which GP surgeries haven't escaped unscathed from, as people struggle to book appointments and access face-to-face appointments.

The country now has almost 2,000 fewer qualified GPs than it did in 2015 and 200 surgeries in England closed between 2018-2022. Figures from the NHS reveal that GP teams are often carrying out more than 1.4 million consultations per day. 

One of the key issues facing GPs is the lack of funding available to invest in improving services, say Dr Ellen Welch, vice chair of the Lancashire and Cumbria Consortium of Local Medical Committees.

A survey conducted by the consortium earlier this year found that 111 of 191 practices in the Cumbria and Lancashire region reported financial stress in terms of reduced income, rising costs, and being unable to afford to recruit staff.

It also noted that there is a 'very real possibility of mass practice closures' unless action is taken.

Dr Welch said: "General practice is collapsing. Practices in our area are struggling to stay open, patients are struggling to get seen, and this is because right now we are not getting nearly enough funding to handle the demands placed upon us. 

"Practices are facing a paradox in which they desperately need GPs but cannot afford to hire them."

The knock on effect of practices being unable to hire more staff is that existing doctors are getting burnt out due to the 'vast amount of unseen work' they do beyond actual appointments, their large workloads, and long working hours.

There's a lot of admin involved which includes checking and actioning results of blood tests and scans, reading and actioning messages from secondary care and patients, and checking and signing prescriptions. 

Burnt out doctors may wind up retiring early or seeking work in the private sector. They might also decide to reduce their working hours to part time instead - but this often still equates to the equivalent of full time work. 

GPs track their working time in 'sessions' with each session lasting four hours and 10 minutes, a typical full-time work week will be made up of 10 sessions. There are also unaccounted for home visits and meetings too. 

This has resulted in the NHS being 'propped up on goodwill.'

Dr Welch added: "‘Part time’ GPs invariably work the same number of hours as a ‘full time’ worker in a 9-5 office job would.

"GPs are ‘part time’ because the job is unsustainable.

"There are huge patient safety consequences to GPs consistently working above recognised safe limits and the negative rhetoric around part-time GPs needs to be quashed.

"Similarly regarding collective action - GPs in England have launched work-to-rule action which means many GP surgeries are focusing on stopping the huge amounts of work that we are not paid or contracted to do - or that it is unsafe to do."

GP partners and contractors across England voted overwhelmingly in favour of collective action - 98.3 per cent voted to take some form of action. 

The British Medical Association is urging them to do this in one of a variety of ways including limiting daily patient contacts per clinician, stop engaging with the e-Referral Advice & Guidance pathway, and serving notice on any voluntary services currently undertaken that plug local commissioning gaps.

But the public can also help with these calls for better support for GPs by writing to their MP and asking them to provide guaranteed funding to stabilise the service.

Dr Welch remarked: "Doctors are patients too and we are all ultimately at the mercy of our struggling system. We are also humans doing our best to help and getting increasingly demoralised.

"For 2024/25 only six per cent of the overall NHS budget goes to core (guaranteed) funding for general practices - this amounts to £107.57 per year per patient - whatever their health needs. Less than the cost of an annual TV licence.

"Our health is worth more than that and the government needs to invest as a priority."

Research looking at 20 countries found that female doctors were 76 per cent more at risk of dying by suicide than the rest of the general population.

Further analysis of this research found that male doctors were more at risk of dying by suicide than other professional groups with 'similar socioeconomic status'.

The NHS provides a wide range of mental-health support for staff which includes 24/7 confidential support services, coaching, and flexible working options.

Dr Welch said: "Wellbeing classes and mindfulness are not going to cut it when staff are in survival mode - GPs ARE burning out, and worse due to all of the above pressures.

"Simply taking collective action (working within our contracts) has been met with criticism when all we are doing is saying we will no longer work for free for the good of the NHS and the cost of out own mental health.

"Sort out the system first, value the staff working within it, who are the biggest resource the NHS has."

The concept of the traditional family doctor that sees a patient from birth to the end of their life is one that is in decline. 

Only 52 per cent of patients regularly see the same GP, according to research conducted by Queen Mary University in 2022. 

There's a positive impact in seeing a familiar face, the researchers also found that patients who see the same GP are more likely to take preventative steps to improve their health and adhere to medical advice given to them.

Dr Welch said: "We know that continuity of care save lives, study have shown this, but it also is easier to see a doctor you know - and a patient you know.

"General practice needs stability right now - with more funding we can train and retain more GPs and deliver the services patients need and make it easier for people to see us."