Opinion Piece: Why you can’t get a GP appointment for love nor money – it’s complicated...

Claire Mitchell, Research Fellow

As part of the NIHR CLAHRC GM research project to address long-term workforce challenges in general practice, we have recently published a review of the available evidence. This looked at the most recent research about why GP numbers are continuing to fall in England and what is being done about it. We also looked at what strategies have been tried to improve recruitment and retention, and whether this is working.

In this piece, I’ll be sharing my perspective on the findings and what I think it might mean for the NHS.

“What is needed is not only action to increase the flow (recruitment) but also work to plug the gaps (retention)”

The bottom line is there aren’t enough GPs – and demand keeps rising

Advances in medical care, better finances and education means people are generally having healthier lives. However, people are also living longer with complex medical conditions and need GP access more and more. So we have a growing older population with increasing medical needs and increasing expectations of what medical care could and should deliver.

In addition to this, NHS care is constantly changing with services being moved from hospitals to community settings and there being a greater focus on caring for people in the community. This is increasing the GP workload as they pick up additional tasks and work with community teams.

So, why can’t we just recruit more people to be GPs?

Our recent research shows it’s more complicated than that.

New GPs being trained are just as important as retaining the ones that have already been trained. There is a damaging combination of not training enough GPs, older GPs retiring early and newly trained GPs leaving, not returning or seeking reduced hours. To make matters worse for patients the impact of difficulty with recruiting GPs can be magnified in areas with the highest deprivation where recruitment is even harder.

So although we need more GPs than ever before, in 2018 the number of GPs is still going down and those that are left have too many patients to look after.

A helpful way to look at this is to think of the supply of GPs as a pipeline.

Recruitment is the flow into the pipeline and the leaks are when GPs leave and don’t return early in their career, or retire early. What is needed is not only action to increase the flow (recruitment) but also work to plug the gaps (retention) in this leaky GP pipeline.

This all means that you are left struggling to get an appointment with your GP.

Increasing the flow:

Why is recruitment difficult?

Choosing to be a GP is not a very popular career decision among medical students. This is for a variety of reasons including perceptions that they are less respected by other doctors, that the job is less intellectually challenging than specialist work in hospitals, concerns about heavy workloads and limited career progression.

On the other hand, medical students and trainee doctors associate GP work with job satisfaction, good work-life balance and being more family friendly than other medical specialties.

However, it takes time to change the negative attitudes of medical schools. There are signs that this is changing but it takes years to train a GP and it will take time to increase the flow of students choosing GP careers – so this is not a quick fix for GPs and patients right now.

Plugging the gaps:

Why are GPs leaving the profession, retiring early or not coming back to work after a break?

It is complicated, there are lots of reasons and these vary from GP to GP. Many say that excessive workload and administrative tasks top their list of reasons for wanting to leave. They are often frustrated with repeated organisational changes in the NHS and feel as though they have no say in this.

GPs report feeling negatively portrayed and criticised by wider society and in the media. They can feel un-supported with little job satisfaction. These along with other related issues are taking their toll – with 40% reporting mental health problems.

Many GPs want more of a mix to their everyday workload; so instead of always working directly with patients, they want to work in other medical specialties or settings. A desire to have an acceptable work-life balance means that many GPs are now reducing their working hours to a manageable level.

Surely someone is trying to increase the flow and plug the gaps?

This crisis has been long predicted but continues to cause a headache for NHS England, the Department of Health, the British Medical Association and the Royal College of General Practitioners. We found that lots of different things are being tried to improve recruitment and retention of GPs at different levels all around the country including:

• Highlighting the rewards of working as a GP
• Providing medical students with high-quality opportunities to see how GPs work
• Increasing support for GPs
• Reducing workload
• Improving career progression and opportunities
• Addressing their work-life balance
• Recruiting more GPs from overseas
• Working in new ways
• Training other health professionals to support GP work.

Looking at the future

There is some evidence that GP recruitment numbers are starting to improve but the impact of this may take time to filter through the pipeline. We don’t yet know if other strategies are working as it is not always easy to measure impact and in some cases, these are long term.

In the meantime, we may expect changes to the traditional GP appointment and workload. The introduction of skill-mix with other health professionals in new roles to try and reduce the GP workload is not without challenges. The increasing use of triage to direct people to other professionals is another tactic but changing attitudes takes time, and patients still complain about the ‘nosey’ receptionist. There is also encouragement to use technology solutions but whether this is practical for the increasing older population remains to be seen.

NIHR CLAHRC GM is continuing to monitor GP recruitment and retention as research continues to address the workforce challenges so crucial to the future of General Practice. Follow the link above to find out more.

Date Published: 18/01/2019