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Rightly, the tragic events of Grenfell will dominate the headlines for the coming days.
The nation needs time to digest the inquiry report. Politicians, who will have had pre-sight, will deliver their carefully crafted responses. Named professionals and manufacturers will run for cover and...
... the residents and relatives will face another interminable wait as the catastrophe moves to the courts.
At any other time a worrying report, published yesterday about NHS primary care, would have occupied wall-to-wall headlines.
But, understandably the media's attentions are elsewhere.
The report is a clever piece of work from University College London and the London School of Hygiene & Tropical Medicine.
They have distilled data-sets from; national administrative general practice via NHS Digital (now part of NHSE), Office for Health Improvement and Disparities, and the Care Quality Commission…
… interestingly, some of the CQC data couldn’t be made to match the actuality.
The authors give us a look at general practice, trends and prospects. The data about primary care and GP practices is a disparate collection and as far as I know, never before has anyone attempted to bring it all together … figure-out what it tells us.
I guess we all know things are ‘not right’ in primary care but the extent of ‘not right’ has never been spelled out with such clarity....
To cut to the chase… the upshot is grim. The Guardian who did publish the report tells us;
‘One in five surgeries closed between 2013 and ’23.’
... and the impact is savage.
The average number of patients on each surgery’s books rose by 40% over the same period.
The total numbers being looked after by GPs has gone from 56 million to 62.4m and although the overall number of GPs working in the NHS rose, after taking changes in working hours into account; full time equivalent GPs per 1,000 head of population, fell by 15%.
Now you can see... why you can’t see... a GP!
However, mysteriously, one million of us, every day, a record, are being looked after in primary care.
Patient volumes are up and so is their complexity.
That’s the clue… ‘in primary care’. Practice nurses and other staff such as pharmacists, physiotherapists and mental health counsellors are playing an increasing role in ‘seeing patients', to ‘help ease GPs’ workloads and improve access’.
Primary care is a team game. As the report tells us;
- the general practice workforce is predominantly female
- there was a rise in multidisciplinary direct, patient care
- nursing numbers are stable
- administrators are up
- GP numbers per head of population fell, to the point where England would be in the OECD bottom quartile.
The report also says that the size of GP practices is on the up…
... federations, multi-site providers, limited companies creating ‘a brand’ and amalgamations with Trusts.
We are left with the question; how long will the partnership-model and family practice be able to hang-on?
The important takeaway from this work is a feel for the future and that family practice is at tipping point.
HMG say there will be another 1,000 GPs by the end of the year… three months. I doubt it…
… and if there are, they’ll be inexperienced, most likely to be female who predominantly work part-time.
They'll very likely, be part of a cadre of new doctors who understandably, might well have a preference to work in the leafy-areas where the schools are good and the environment clean and green for their families and …
… they cannot make up for the loss of experienced GPs through retirement and disillusionment.
I'm hearing reports about the Darzi-draft. It’s a rehash, pushing for hubs and agglomerations… which will take time, capital and complex agreements.
As the report observes;
‘… the implication [is]… the shift towards larger practices, multidisciplinary teams, a predominantly female workforce, the fall in the number of practices and FTE qualified GPs needs careful observation in relation to their impact on quality, equity and costs.’
I just wonder how much more ‘observation’ we need to know this won’t end well.
Industrialised, impersonal primary care, decisions made by the well intentioned, enhancing risks and costs… inevitably adding to demand by the failure to get decisions right-first-time.
The misbegotten belief that common conditions can be treated commonly, ignores the substantial risk that common conditions can often mask, or even erupt, into uncommon conditions with exceptional consequences.
This report is an excellent piece of work that demands an excellent response but...
... don’t hold yer breath.
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