Vanishing GPs are to blame

By a former NHS consultant who says too often his profession’s ethos of care and duty has been replaced by self-interest

THE GP surgery was once the hub of British healthcare and the heart of a community — but no longer. Too many GPs have become unresponsive and unavailable, with the traditional out-of-hours and weekend services all but disappearing.

The explanation for this collapse in provision is simple: the last Labour Government, in an act of wilful negligence, actually paid doctors to reduce their care to patients.

During the negotiations for the new GPs contract in 2004, the then government’s representatives caved in to the demands from the British Medical Association (BMA) whose negotiators could not believe their luck.

Doctors were to be paid more for working less, a complete inversion of morality and common sense.

In return for a payment of just £6,000, they were allowed to pull out of providing any out- of-hours or weekend services. Today ‘Partners’ in GP surgeries earn, on average, £102,000 a year, while one in ten earn more than the prime minister’s salary of £142,500.

At the time of the negotiations, I was chairman of an NHS Trust and told my chief executive: ‘This means that A&E will be flooded by people who should be seen by their GPs.’ That is exactly what has happened because too many patients simply cannot get a GP appointment when they need it.

The reality of the diminishing GP service has been brutally highlighted by this week’s report from the National Audit Office, which showed that 46 per cent of practices are closed at some point during the core hours of 8am to 630pm, while almost one in five surgeries are shut by 3pm at least one day a week.

Disastrous

Many others closed for one or two hours over lunch, or from 5pm. Patients are advised to call 111 — or go to A&E! Unsurprisingly, the NAO report showed patients at practices with shorter opening hours had higher rates of A&E attendances and higher mortality levels.

Today, the Mail’s national survey of 20 GP practices and clinics reinforces the picture of diminishing provision, with one Manchester practice closing at 11.40am one day a week.

In essence, doctors were handed financial incentives to give up what used to be an integral part of their duties. The damage to the provision of services is bad enough. But there has been a disastrous knock-on effect for some of the profession that I also blame on that flawed contract.

Many doctors are dedicated and hard-working. But in place of the old tradition of selfless compassion and responsibility, there is, among some, a new spirit of greed and entitlement, masquerading as concern for the public. That could be seen all too clearly in last year’s disgraceful strikes by junior doctors, who blathered about the safety of patients but were only interested in money.

As they took industrial action, their laughter and political sloganising on the picket lines were graphic indicators of a profession — my beloved profession — that has lost its way.

That same self- serving attitude can be found among too many of today’s consultants, who, despite their excellent pay, insist on rigorously sticking to their contracted hours, regardless of patient needs.

And so daily the sense of crisis continues to deepen in the NHS. A system once seen as ‘the envy of the world’ is in meltdown as A&E units struggle to cope with record demand.

Trolleys have become a substitute for hospital beds — the number of patients spending more than 12 hours on a trolley has doubled in two years — while adults are being admitted to paediatric wards in some hospitals.

Social care is failing to meet the needs of the elderly, so those ready to be discharged from hospitals must remain there until follow-up care is in place. A letter to the Prime Minister this week from the Royal College of Physicians, signed by 49 members of its council, warned that hospitals are ‘paralysed by spiralling demand’.

In a parliamentary debate on the crisis, Labour and other opposition parties heaped scorn on the Government yesterday. Health Secretary Jeremy Hunt and his colleagues were accused of incompetence, misguided priorities and a failure to provide adequate funding for the NHS.

Myths

That last charge has long been a favourite of Labour MPs. In their narrative, health expenditure is never sufficient; services are always ‘under-resourced’.

In this case, the claim is a hollow one. The Tory Government has poured extra money into healthcare, with spending up from £75.8 billion ten years ago to £116.4 billion last year. The NHS budget is due to rise to £133.1 billion within five years.

Contrary to the myth-making about ‘savage’ cuts, the number of staff has increased in recent years. Official figures for 2014 show there are 33,000 more doctors and 18,000 more nurses in the NHS than a decade earlier.

No, the real cause of the crisis lies in the structure of frontline health services. There have been two other catalysts in the breakdown of GP services. One is the size of pension pots, now so big for some GPs, they have reached the limit of the lifetime allowance for tax relief purposes.

From May this year retirees will have to pay a punitive 55 per cent tax on any portion of their pension worth more than £1 million. So they are often advised by accountants to work parttime to avoid tax penalties.

And with a healthy income guaranteed, many take early retirement, something that is not possible for private sector workers who do not enjoy taxpayer-subsidised pensions.

Then there is the increasingly feminised nature of the general practice workforce, with almost half of GPs now women. In theory, this is welcome — equality of opportunity is an essential principle of our society. But we have to face the fact that women with family responsibilities are far more likely than men to go part-time in general practice.

Of the 1,221 female GPs who left the workforce in 2012-13, 469 of them were under 40.

Unreliable

Added to this is a recruitment crisis: more young doctors are opting for hospital careers or moving overseas because, despite the financial incentives, the physical and mental pressures on those in the GP sector is rising as the population ages and immigration increases demand. Across Britain more than one in ten full-time GP positions are vacant.

What we are seeing is the impact of these influences. All the extra funding for GPs is disappearing down a black hole because a seven- day-a-week operation has given way to a patchy, unreliable system, led by an over-paid, part-time workforce, propped up by inadequate agency cover with staff whose training is sometimes as lacking as their grasp of English.

The BMA used to be a serious professional body. Tragically it has become an ultra-politicised trade union, ruthlessly exploiting public sentimentality about the NHS to line its members’ pockets and act as a block on any structural reform.

The BMA, with its cheerleaders in the Labour Party, is one of the reasons so much extra funding for the NHS is wasted.

That is why it is the height of folly to believe that yet more cash will be the solution to the present crisis, a crisis that begins with GPs.