At a time of transformation and uncertainty for the NHS, Healthcare Leader reveals how primary care staff view the sector’s present situation and future prospects
In March, Healthcare Leader’s publisher Cogora released its Primary Concerns 2018: The State of Primary Care report, revealing how those who work in the sector really feel about the shape it’s currently in. The annual survey, which this year gathered responses from more than 2,300 salaried GPs, GP partners, pharmacists, practice managers, nurses and healthcare assistants, canvassed opinion on everything from working hours, morale and stress levels, to abuse from patients, transformation and the impact of Brexit
1. Low morale at work
The report found low morale to be an issue across primary care. Of the 2,386 survey respondents, 46% rated their work morale as ‘low’ or ‘very low’, with the percentage for GP partners and salaried GPs being even higher at 53% and 50% respectively.
The top five factors impacting negatively on work morale were: ‘unrealistic demands from patients’ (51%); ‘feeling unappreciated by NHS management’ (43%); ‘too much bureaucracy’ (42%); workload ‘dumping’ from other NHS sectors (35%); and ‘unfair NHS criticism from politicians’ (33%).
With morale as low as it is, it’s no great surprise that a quarter, 25%, of primary care professionals would consider quitting their job within a year for reasons other than retirement. At 30%, practice managers were the most likely to think of leaving within 12 months, closely followed by pharmacists at 29% and salaried GPs at 27%.
2. Stress and burnout
Despite working long hours, battling mounting bureaucracy and feeling underappreciated, the majority of primary care professionals had not taken time off for stress or burnout in the 12 months preceding the survey – and had no definite plans to do so in the coming year.
Nearly two-thirds, 65%, said they had not and did not expect to take time off work as result of burnout or stress, while 23% had not taken time off for this reason in the past year, but did expect to in the next 12 months.
GP partners were among the least likely to have had time away from work, at only 7%, closely followed by pharmacists at 8% and practice managers at 9%.
3. Abuse from patients
Abuse from patients ranked relatively far down on the list of contributors to low work morale – with 12% stating that verbal abuse was ‘very influential’ and only 3% saying the same of physical abuse. Nevertheless, almost two-thirds, 64%, of respondents had received verbal abuse from patients in the previous 12 months.
This figure was significantly higher for pharmacists and practice managers, at a shocking 80% and 79% respectively, while the percentage for GP partners and salaried GPs was just under the survey average – 56% and 60%. Other types of abuse were thankfully much more rare.
Overall, 18% of primary care professionals had received written abuse, while 4% had experienced physical abuse. Sexual abuse, included in the research for the first time, was something 1% had been the victim of. One third of all respondents, 33%, said they had not received any abuse from patients.
4. Work-life balance
Primary care professionals’ work-life balance leaves a lot to be desired, with 40% of respondents saying they worked unpaid overtime on a daily basis and nearly three in 10, 29%, doing so a few times a week. Just 5% said they never worked beyond their contracted hours without pay.
For salaried GPs, the rate was substantially higher – with 52% putting in unpaid extra hours every day. Tying with practice managers, also at 52%, this was the highest figure for any of the professions.
Respondents were not forward about asking for better conditions or pay, with close to half, 46%, saying they had not done so in their current role. However, of those who had asked for a pay rise, 56% had been successful, with the average pay increase a respectable 11%.
5. Pressure and cutbacks
In light of the pressures on general practice, the report asked GP partners about the impact on their practice, as well as any steps taken to mitigate it.
As many as 41% of GP partners said they had considered discontinuing certain clinical services in order to manage, or had already done so, and 28% said that they either had or were contemplating cutting some routine appointments.
Just under a quarter, 23%, had or were looking to cut staff hours. Although the survey was carried out before the publication of the long-term plan in January and the announcement of the introduction of primary care networks, the findings reveal that many practices were already working together – perhaps in a bid to improve their chances of survival.
Just over a third, 36%, had merged with another practice or were considering it, while nearly half, 49%, had become part of a federation in the last 12 months or were thinking of joining one.
6. Transformation and collaboration
Although many practices were already working at scale, primary care professionals were not overly convinced by taking steps towards integration.
Close to a third, 28%, were ambivalent about the effect of sustainability and transformation partnerships (STPs) on the quality of patient care, while 24% felt the effect was ‘negative’ or ‘extremely negative’. Only 6% thought the impact had been ‘positive’ or ‘extremely positive’. GP partners were the most negative, with 54% stating that STPs had an extremely negative effect on patient care.
Respondents were also unenthusiastic about any positive change as a result of NHS England declaring that STPs should spend 15%-20% of their funding allocation on general practice. As many as 59% said they had not witnessed any improvement, with 12% saying they had seen ‘some’ improvement and a minimal 0.9% stating that it had led to ‘substantial improvement’. GP partners were overwhelmingly the most negative, with a whopping 72% of the view that it had not resulted in any improvements for general practice – echoed by 66% of practice managers and 55% of salaried GPs.
The majority of respondents, 32%, felt the upscaling of primary care had had a neutral impact on the quality of patient care, and 11% that the effect had been ‘positive’ or ‘extremely positive’. Primary care professionals were similarly unimpressed with the GP Forward View, with the majority, 59%, replying that they had not seen any improvement as a result of its launch three years ago.
Just 1% considered that there had been ‘substantial improvement’. Nearly a fifth, 19%, did, however, concede that the GP Forward View had led to ‘some improvement’.
7. Expanding the primary care team
NHS England is promoting multidisciplinary teams as one solution to the GP recruitment crisis and it seems primary care professionals are largely in favour of this.
Among these newer practice roles, pharmacists were the professionals that GP surgeries were most likely to already be working with, or consider hiring. Almost half, 48%, said they already employed a practice pharmacist and would continue to do so, and 39% said that they would consider employing a pharmacist although they did not currently. Just 8% would not hire one.
Uptake was lower for other professions, with 10% currently employing a mental health therapist – although 59% of those who did not employ one would consider doing so in the future. However, 15% said they had not and would not consider hiring one.
Just 6% of respondents had a physician associate on their team, although an overwhelming 91% of those who did wanted to keep them on. Almost half, 45%, would consider bringing a nursing associate on board after the role was introduced in January this year, but had no immediate plans to do so. Nearly a third, 32%, were unsure if this would be the right move for their practice, while for a fifth, 21%, it was a flat-out no.
8. Brexit fears
Unsurprisingly, primary care staff are worried about the impact of Brexit on the NHS. Three-quarters, 75%, of respondents believed Brexit would have a negative impact on the number of nurses, while almost as many, 71%, thought it would have this effect on GP levels and 67% that it would affect other primary care staff in a similar way. A limited number, 3%, thought Brexit would be positive for the number of nurses, GPs and other primary care staff.
Nearly two-thirds, 64%, thought Brexit would be detrimental to the availability of medicines – with just 3% believing it would be beneficial. Just over half, 54%, thought it would lead community pharmacists to stockpile medicines.
There was also concern about finances, with 54% of the view that Brexit would pose a threat to the NHS budget and 59% believing it would negatively impact on the amount of time staff spend assessing patients for care.