The NHS has "the wrong workforce" to cope with the future health needs of the country, with medical schools training too many hospital specialists and not enough GPs to cope with overwhelming patient demand, the new chair of the influential Health Select Committee, Dr Sarah Wollaston, has said. Dr Wollaston also warned that the health service faces a crisis in the GP sector and that more should be done to encourage those who have left the profession, particularly women, to return to help relieve the pressure.
Dr Wollaston, Tory MP for Totnes, Devon, and a former GP, said there was "a huge bias" in medical training for doctors to train for work in hospitals, despite a growing consensus that the future of the health service lies in caring for patients closer to home – with GPs seen as key to new models of care.
The Health Select Committee said last week that 15 million NHS patients with long-term conditions such as diabetes, arthritis and asthma now represent 70 per cent of the work the health service does. Improving GP and community services will be crucial in preventing medical emergencies associated with these conditions that would require expensive hospital care. The "closer to home" strategy is seen as key for ensuring that the NHS, which is facing a £30bn funding gap by 2020, will be sustainable for the future.
However, the MP warned that "a real workforce crisis" in the GP sector, particularly in rural and deprived areas, threatened to undermine patient care.
Dr Wollaston worked as a GP before entering Parliament in 2010 and also has experience of training junior doctors. She believes one way the NHS could "very quickly" begin to address the GP workforce crisis would be to attract women who have left work to have children, back into the profession.
"We've got the wrong workforce," she said. "What we do, still, is train too many doctors out of medical school, to become acute hospital specialists in specialities for which there are no jobs. They might have four or five years of training to become a particular hospital specialist when everybody knows there won't be a job for all of them. And yet in general practice we've got huge vacancies."
Only a decade ago there were 2,500 more GPs than hospital doctors in England. But by 2012 that balance had shifted, with 31,700 GPs against 38,200 hospital doctors.
Dr Wollaston said that much of the problem lay in the training doctors received in medical school. "There's not enough of their training focusing on where we need doctors in the future – generalists in primary care … we encourage them, through medical school, to think that the only show in town is becoming an acute hospital specialist. There is not enough prestige and not enough emphasis at medical school placed on primary [GP] care – some medical schools are better than others, some do focus on primary care, but others don't."
However, with patients reporting that it is becoming harder and harder to get a GP appointment, and doctors' leaders from the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) warning that the profession is approaching the limit of its ability to cope, Dr Wollaston said one short-term measure that would relieve pressure would be to clear the barriers which stop trained doctors who are not working, from getting back into day-to-day patient care.
"We've got a very large female workforce now in general practice," she said, "many of whom step out for childcare commitments. Let's very quickly try to bring those women back into the workforce through returner schemes. It takes four years to train a GP, it takes a very short time to get someone back in the workforce who's been out for three or four years."
NHS statistics reveal 65 per cent of GPs in training are women, but that 40 per cent of women who leave general practice are under the age of 40. The RCGP is working on a campaign to encourage women who have left work for childcare, and other trained GPs who have taken time out, back into work. The college has heard anecdotal evidence that "good quality and experienced GPs are being discouraged from returning to UK practice" – in particular by the cost of having to pay for their own re-training.
Dr Maureen Baker, the chair of the RCGP, called the "significant barriers" faced by GPs wanting to get back into work "ludicrous", saying: "We desperately need more GPs and practice staff. It is ludicrous at a time when we are seeing the general-practice workforce depleting that there are very significant barriers to [allowing] people to return to careers in general practice, caring for patients."
Dr Baker added that the RCGP was looking for funded schemes to support doctors, "so that they can have a safe, protected route back to practice and ease workforce pressures across the NHS". Surgeries are being encouraged to invest in "return to work" re-training schemes that are more cost-effective than training new GPs. It is estimated that there are hundreds of trained GPs who could return to practice.
Dr Chaand Nagpaul, of the BMA's GP committee, said: "It is unacceptable that female GPs who have taken periods of leave after having children face barriers when returning to work. It is important for GPs to be encouraged back into the workplace, particularly at a time when general practice is facing a workforce crisis.
"It is essential that the funding is ring-fenced for returner schemes, which allow GPs to return to practice, and retainer schemes which allow them to remain part of general practice during their time off. There is currently a huge disparity in the funding offered across the country, and highly skilled, dedicated GPs are being prevented from providing the care our patients need."
Cambridge GP Dr Fiona Cornish, a past president of the Medical Women's Federation, said the NHS was "missing out" on "hugely experienced, valuable GPs" by making it difficult for women who wanted to return to work.
"We need them more than ever," she said. "Younger doctors don't want to go into general practice, they see it as an unstable and demotivated profession because of the media bashing and constant denigration by the public and politicians."
A spokesperson for Health Education England said the number of GP training posts has been increased in 2014, with a target to provide a total of 3,250 GP training places.
"This work includes a review of the GP recruitment process, development of a pre-GP year for prospective applicants, and careers advice for foundation doctors and medical students," the spokesperson said. "We have also just started conversations with the Royal College of General Practitioners – in relation to a possible GP Return to Practice 'campaign' in the near future."
The cure that isn't working
Pressure on the Government over GP access increased last night as it emerged that it has produced an action plan to improve services in primary care which is already failing.
NHS England quietly produced the six-point "call to action" strategy a year ago to reverse the growing dissatisfaction with GP services. Yet figures released last week showed that, on all the indicators, approval among patients has fallen.
Access to a family doctor is threatening to become the next big crisis in the NHS, with patients' groups and MPs increasingly alarmed that waiting longer than a week for an appointment is becoming more and more common.
The strategy "NHS England: Improving General Practice", included six key indicators to highlight "growing challenges in relation to patient experience of access". These are: the overall experience of their GP surgery; overall experience of out-of-hours GP services; the ease of getting through on the telephone; ability to get an appointment; overall experience of making an appointment; and ability to see a person's preferred GP.
When the six indicators are compared with a published survey of patients, satisfaction with services are shown to have deteriorated.
The survey of nearly one million patients published last week showed that a quarter of patients are waiting more than a week, and one in 10 gives up trying to see their GP – instead heading to already overflowing A&Es.A third of people felt they had to wait too long for a GP in the evenings and at weekends, while a quarter found it difficult to contact a surgery by phone.
Labour said the revelation of the six-point plan showed that the Prime Minister's claims in the Commons last week that the NHS was better under the coalition were not true.
The shadow Health Secretary, Andy Burnham, said: "David Cameron will be embarrassed by this. It... shows that his plans are simply not working. The reality is that he's made it harder to get a GP appointment and there is now growing public dissatisfaction. Labour will scrap Cameron's NHS market and invest the savings in helping patients get a GP appointment when they need one...
"While the Government tries to claim that everything is fine, people know from their own experience that the NHS is heading downhill."
Last week, Dr David Geddes, head of primary care commissioning at NHS England, said that overall experience of GP services was good, but conceded: "We need to recognise the continuing trend in what patients are telling us about access to services, particularly out of hours."
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