Rise of the part-time family doctor

Average GP works for just three-and-a-half days a week as patients’ groups warn of strain on the NHS

THE average GP now works less than three-and-a-half days a week, and just one in 20 trainee doctors intends to do the job full time, research shows.

Patients’ groups said the rise of the part-time GP was “terrifying” given the national shortage – fuelling ever longer waits for an appointment.

But GPS said the job had become so intense that full-time working was increasingly “untenable”. The survey of more than 2,000 family doctors shows that on average, they are now carrying out 6.7 half-day sessions a week – the equivalent of three and a third days and the lowest figure on record.

Patients’ groups said family doctors were lucky to be able to opt for parttime hours, with average earnings of more than £100,000 for a GP partner. For the past five years, female GPS have outnumbered male family doctors, adding to demand for family-friendly working.

Separate polling of more than 700 trainee GPS reveals the vast majority have no intention of ever working full time as a family doctor.

Just 22 per cent plan to be working full time as a GP within one year of finishing their training, the research by the King’s Fund found. Almost twice as many – 42 per cent – intended to take on lucrative locum work.

The majority expected to take on other jobs – either in addition to work as a family doctor, or instead of it. While just over half said they intended to do other clinical work for the NHS, 27 per cent intended to work privately, while 20 per cent planned to work abroad.

It follows warnings from health officials that the NHS needs up to 200,000 more staff to adjust to the expectations of younger “millennial” workers who were more likely to opt for part-time working. Patients’ groups said the latest findings were “terrifying”.

Joyce Robins, from Patient Concern, said: “The situation is bad enough right now; it is extremely hard to get an appointment, and patients face ever-longer waits. GPS are incredibly well paid, and are lucky that they can afford to work part time, but the public cannot afford the rise of the part-time GP.

“It costs a lot of money to train them, we need far more of those who are prepared to do it as a full-time job.”

Rachel Power, chief executive of the Patients Association said: “These findings are very worrying for patients. If these trainees translate their current plans into career choices, it will only become harder to get an appointment with a GP in the years ahead, and therefore harder to get access to many NHS services as a whole.”

The crisis was worsened by the increasing numbers of GPS opting for retirement, she said. The latest figures from NHS Digital show 83 per cent of female GPS and 52 per cent of male GPS work part time. The survey of 727 GP trainees found that just 4 per cent of women, and 8 per cent of men wanted to be working full time as a GP within a decade. The top three reasons were the “intensity of the working day,” long working hours, and family commitments.

Beccy Baird, senior fellow from the King’s Fund, said: “We need to do more to address the working lives of GPS. Stress is going up, they are retiring increasingly early. This isn’t about lazy GPS who earn so much that they can afford to work part time.”

Prof Helen Stokes-lampard, chairman of the Royal College of GPS, said GPS faced heavy pressures, amid a shortage of 6,000 doctors. “The intense resource and workforce pressures facing general practice at the moment, mean that full-time working as a GP is often regarded as untenable,” she said.

In June, Ian Cumming, chief executive of Health Education England, warned that four in 10 GPS were quitting the health service within five years of finishing training – having each cost the taxpayer around £500,000 in training.

He said: “They are doing short-term locums, they are doing other things. The millennial generation want more flexibility, they want to work different hours, they want to change career more regularly.”

It says something about Britain’s health system that, despite all the money that is spent on it, the average GP only works for around three and a half days a week. That figure comes from official data; King’s Fund research also shows that it is part of a trend. Only one in 20 trainees say they see themselves working full time as a GP within a decade. The reasons include the intensity of the work, long hours and family commitments, but this also shows how broken the contract arrangements are. Patients deserve far better value for money.

Employees in other parts of the health service are paid less and are over-stretched – and the difficulty of seeing a GP at a time convenient to many of us adds to the problem, as patients are forced to join long queues at A&E. GPS have always been special – they escaped nationalisation in 1948 – and when New Labour came to power, it made the situation worse by negotiating a contract that offered them more cash to do less work.

And yet every treatment in the NHS still begins with one’s GP: they are gatekeepers to seeing a specialist, having blood tests etc. This made sense back when there was such a thing as a family doctor, but it’s becoming harder to build and maintain such a relationship. The population has grown; Britain has not trained enough new doctors to keep up with rising demand.

The Government now needs to make a decision. Either local surgeries recognise that they have to justify the amount of money they get and offer more convenient services – such as out-of-hours appointments – or perhaps the time has come to cut out the middle man and reduce our reliance on GPS. Why, for example, does someone with a recurring complaint being treated in the hospital system have to keep going back to their local surgery for consultations?

The notion of polyclinics was once floated (offering a range of services under one roof or within one area) but was shot down by the British Medical Association, which is an old story. Some attempt is made to reform the system; the medical establishment complains; the government of the day caves in. It seems the only politically correct argument when it comes to health is taxing more to spend more, yet in GP surgeries we have evidence that simply paying a great deal of money isn’t enough. On the contrary, it results in a system that does its best to suit some doctors while letting down their patients.