This site is intended for health professionals only

CCG Series: General practice and innovation


23 September 2014

Share this story:
What does the general practice crisis mean for the future of the health service? In the first of a two-part blog, Dr Nadim Fazlani explores current issues GPs are facing
There’s a real air of crisis in general practice and GPs up and down the country are running hard just to stand still. 

What does the general practice crisis mean for the future of the health service? In the first of a two-part blog, Dr Nadim Fazlani explores current issues GPs are facing
There’s a real air of crisis in general practice and GPs up and down the country are running hard just to stand still. 
Back in 2007 a survey on GP workloads showed that the average patient consulting 3.19 per annum while the corresponding figures for 2013 was 6.34. Simon Stevens on 1 September told the Public Accounts Committee that over the last ten years there has been an increase of 76% in whole time equivalent consultant figures. 
There has also been a very significant increase in staff grade and specialist numbers as well.  In terms of head count, in 1995 the number of GPs per 100,000 of population was 54 and in 2009 corresponding number was 59.5. Of course, as the workforce is increasingly part time and female, the whole time equivalent numbers are difficult to estimate. 65% of GP trainees are female and 40% of those who leave practice each year are under the age of 40. There are no accurate figures on when they come back. 
The Health Education England target of 3,250 trainees per year remains aspirational and the actual number remains at around 2,700. In our current one-to-one training model it is unlikely that we have capacity to train 3,250 trainees any way! Medical student intake is being reduced by 2% so the current pool is unlikely to be able to provide that number of GP trainees without a reduction in speciality training numbers. 
However hospital trusts are struggling to fill their current acute on call and accident and emergency rotas. So we have the perfect storm – and I’ve not yet mentioned the number of GPs who are above 50 and looking forward to retirement!
As we’re very unlikely to have the number of GPs needed to sustain our current model of working, we really have to look at different models of working. I’m not a pessimist and I am not predicting death of general practice. I still remember the obituary written in BMJ which claimed that general practice died on 31st March 1990 after a turbulent illness, in large part precipitated by the importation of industrial management into general practice. 
New roles
General practice is in crisis but general practice has always changed and innovated and come through crises. So I’m confident that it will do so again.
It would be difficult to argue with the vision laid out by the Royal College of General Practitioners in The 2022 GP: A Vision for General Practice in the future NHS. 
We are in a time of transition and moving away from the twentieth-century model of a reactive model with its divisions of hospital-based and community-based practice and of health and social care. We need to move instead towards a twenty-first century system of integrated care, where clinicians work closely together in flexible teams, formed around the needs of the patient and not driven by professional convenience or historic location. 
General practice has changed a lot over past 25 years that I‘ve been a GP but I believe that years to 2022 will be the greatest time of change.
So how should that change happen, what should be the new roles and responsibilities? What are the structural forms that would deliver this? What should be the role of clinical commissioning groups (CCGs) in facilitating this change? 
I believe that CCGs have a part to play in this; they are membership organizations and should work with patients, public and other clinician’s to help design and implement the new models of general practice. 
I would give my perspective on these questions in future blogs. 

Want news like this straight to your inbox?

Related news


New ONS data gives false impression of health inequalities facing ethnic minority groups
New figures from the Office for National Statistics (ONS) which found that ethnic minority groups...
RCGP sounds alarm with emergency action plan as GPs reach ‘breaking point’
General practice is at ‘breaking point’ and urgent action is needed from the Government to...