‘De-risking’ and financial exclusion
Isn’t it hard to get an appointment with your GP these days? The anecdotal consensus is that it’s harder than it used to be. A two or three week wait is not unheard of.
David Cameron has recently announced that he wants GPs to open for up to 12 hours every day by 2020 with the ostensible aim of relieving pressure on hospitals and giving working people access to a doctor at weekends. To show he is serious, the Prime Minister has offered to provide additional funding (£400 million over the next five years) to ensure that as many surgeries as possible open from 8am to 8pm.
Innovations in the way GPs work are also being encouraged by the government with doctors being required to consider consulting via email, telephone and video-call software such as Skype.
Improving GP access would certainly be a good thing for patients. It would likely result in better outcomes (earlier consultant referrals, earlier diagnoses, and earlier commencement of treatment). It would also be better for the NHS budget overall. Spending more on GPs (who deal with 90% of patient contact in the NHS while costing less than 10% of the budget) actually saves the NHS money. The average 12-minute GP consultation costs £36 compared with the average A&E admission which costs £68.
However, as with all bottlenecks in the 21st Century NHS, there are practical difficulties on the ground that even improved funding will not necessarily erase or even ameliorate.
For a start, demand has gone up. There are many more people in the UK than there used to be, even just 10 years ago. Taking population growth aside - demand has also increased because the average patient sees the doctor 6 times a year (twice as often as 10 years ago) and because people are living longer and older people generally have more complicated (usually chronic rather than curable) health conditions.
Added to this problem of increased demand (perhaps partly because of it) is the fact that morale amongst the GP profession is at an all-time low which has led to a recruitment crisis. Doctors are warning that one-in-three GP training places for this year have yet to be filled (fewer than 40 graduates applied for 148 GP training places in one area of England for the August 2015 intake) and the figures from NHS England showed the number of GPs per head of population has fallen from 62 in 2009 to 59.5 in 2014.
It’s just as bad at the other end of the age spectrum with one in three GPs intending to retire in the next five years based a BMA surgery of over 15,000 GPs earlier this year.
The issue has certainly angered the GPC Chair, Dr Chaand Nagpaul who has denounced moves towards a seven-day service describing this as a ‘political pipe dream’ that will lead to the destruction of ‘comprehensive general practice service in parts of the UK’. Dr Nagpaul envisages the number of GPs leaving the NHS over the next 5 years to be considerably higher than those recruited, even with additional government funding, thereby putting additional strain on a dwindling resource and driving down morale further - a ‘catastrophic timebomb ready to explode’ in his words.
The victim of this metaphorical explosion will inevitably be patient care (it always is), leading to an increase in the number of clinical negligence related injuries. GPs and their liability insurers (who often have to compensate patients for their injuries when things go wrong) are well aware of this. According to a Medical Protection Society (MPS) survey of 600 GP members, 88% of those polled believed that they were more likely to be sued now than five years ago.
The MPS and the other medical liability insurers who GPs are usually indemnified by are understandably keen to limit their financial exposure. However they do not always choose to do this lobbying for improvement in healthcare standards but rather by trying to change the law to make it harder for injured patients to claim compensation when things go wrong.
For example, on 18 May 2015 the MPS issued a press release calling for fixed legal fees for small value claims against GPs which would make it more difficult for injured patients injured to obtain the quality of representation needed to claim compensation.
This press release followed an earlier press release by the MPS dated 23 February 2015 which stated that being sued could have a significant impact on the health of doctors, with most of them feeling it impacted on their confidence.
In response to this, it has to be asked:
The press release concludes with the MPS expressing their concern about the harmful effect litigation is having on individual doctors, and also more widely on medicine – explaining that England needs 8,000 new full time GPs by 2020 but that fear of clinical negligence claims could further harm recruitment drives.
So the morale of the story when you can’t get a GP appointment anytime soon seems to be don’t blame population demographics or the government and definitely don’t blame the GP. Blame the lawyers.
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