The quiet exodus of GPs

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This article appeared in the New Statesman in July 2015

George Osborne quietly slipped into his budget some news that the medical staff perhaps dreaded, perhaps didn’t even imagine was possible: the public sector pay freeze will continue. For another four years.

I’ll just let that sink in. For months, doctors and nurses have been begging the public and the government to take notice: pressure on the wards is building to dangerous levels. Medical staff are overworked, under-appreciated and underpaid, and now there’s this insult to injury – a further slap in the face from a Chancellor unwilling to reward their graft with a share of the recovery, for which they have already sacrificed so much.

It’s so far from justice, such a total misdirection of priorities, it’s taken this long to process.

The Conservatives are on such a high at the moment that judgement seems to be on hold. Back in April at the health election debate, Jeremy Hunt barely managed to defend the Health and Social Care Act, on which the Conservative government’s entire health record will be judged. But last week he unveiled a policy that could only have made it into the X-rated version of the Health and Social Care Act.

And his explanation for why printing the cost of a prescription, with the words ‘Funded by the taxpayer’ on the box would help patients and not just leave them guilt-ridden as well as sick, was so unconvincingly delivered on Question Time that I doubt it would have had much sway in a sixth-form debating society.

But the really galling moment in the show came when a GP in the audience, flushed with anger, attacked his new deal for General Practice, and pointed out what she and all of her colleagues know: it’s a complete departure from reality.

“It’s just not viable,” she said. “It’s just not common sense. You’re driving us all out of the country Mr Hunt. The day you announced your new deal, many many GPs across this country handed in their notice that day. Do you know that?”

It’s a very good question. I have a feeling there’s a lot Hunt doesn’t know, or want to know. I wonder, if I could carry on the GP’s line of inquiry, whether he knows that in a survey of 15,000 GPs by the BMA’s General Practitioners Committee (GPC), carried out earlier this year, 90% said that unmanageable workloads are damaging the quality of patient care.

In its official response to the New Deal announcement, the BMA said: “Health Secretary’s workforce commitments are unlikely to be deliverable in isolation from broader changes in general practice. Unmanageable workloads in the face of increasing patient demand are acting as catalysts for early departure from general practice, and deterring new graduates from entering”.

Hunt dismissed the GP who tried to tell him this truth last night, pointing to his desire to appoint 5,000 more GPs by 2020, rounded off by the put-down, “I thought as a GP you should welcome that”. That’s hardly a surprise – most of the government’s rhetoric on the NHS relies on no awkward interventions from doctors or nurses.

But the facts are on her side. A recent survey carried out by the BMA revealed that one in three GPs is planning to retire in the next five years, and that one in five trainee GPs intends to work abroad when they qualify. All this amid a gruelling period when £22bn worth of cuts have been ordered, a figure Hunt’s former coalition partner Norman Lamb now admits is fantasy.

The New Deal he’s proposing isn’t new, nor does it deal with the workforce crisis. I’m sure Hunt read the transcript of a scathing attack by the chief executive of the BMA, Dr Mark Porter, who branded the New Deal solution as showing “little grasp of reality”.

Speaking at the BMA’s annual representative meeting in Liverpool, Porter said: “How are they even going to recruit more GP trainees when hundreds of existing training posts are still unfilled? They don’t say. When will they provide substance over rhetoric and recycled ideas, to focus on the detail of how they will support GPs already burnt out from overwork, in a service where more than 10,000 GPs are predicted to leave in the next five years? They don’t say.”

With recruitment and retention woefully weak, talk of hiring 5,000 more GPs when the existing, maligned workforce is now bracing for four more years of austerity is being seen for what it is: the “pursuit of easy headlines” that Porter slammed in Liverpool.

Only last week I described the split between the reality of what’s going on in nurse staffing, and the government’s own line. I’m afraid Hunt’s New Deal for General Practice, topped off with Osborne’s financial slap-in-the-face, is yet more of the same make-believe.

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