Huge rise in numbers of ‘managed’ GPs
THERE has been a 885% increase in patients being registered at “managed” GP surgeries in Wales over the past five years, it has been revealed.
Data obtained by the Royal College of GPs (RCGP) through Freedom of Information requests has shown that 151,431 patients were registered at managed practices in 2017-18, a huge increase from 17,104 in 2012-13.
Most practices are run through an “independent contractor” model where GPs and staff are responsible for the day-to-day running of the practice. But in a managed practice those responsibilities are undertaken by a local health board.
Some 4.9% of patients were registered at a managed practice in 2017-18 as opposed to 0.6% in 2012-13.
Many practices have been forced into “handing back” their contract to a health board – becoming a managed practice – because of excessive and unsustainable workload.
The issue was particularly pronounced in North Wales with Betsi Cadwaladr University Health Board reporting 12 managed practices, more than half of the total in Wales. Some 11.8% (or 83,984) of patients in North Wales are registered to a managed practice. In 2012-13 Betsi Cadwaladr had one managed practice serving 1,937 patients.
Whether a practice is run by GPs and practice staff or a local health board has implications for patient care, the value for money of healthcare services, and the role of GP leadership.
Dr Peter Saul, RCGP Wales joint chairman, said: “This is about patient care and what services are available for patients. When workload pressures force practices into handing control to local health boards, availability of appointments and continuity of care can suffer.
“In those circumstances there is a risk of increasing stress on other parts of the NHS, notably out of hours services.
“There are also financial costs associated with practices being run by health boards. Boosting the financial support for general practice would likely prove costeffective in the long-term as it would keep more practices in the independent contractor model.
“These figures clearly demonstrate the pressure general practice has been facing over recent years. Many GPs are being forced into handing their contract back to local health boards because they don’t have the support to meet rising demand.
“Positive steps would include increasing GP training places, boosting investment in general practice, and addressing excessive workload to keep GPs in the profession.”
Last week the Welsh Government launched the second phase of its Train, Work, Live marketing campaign to entice more medics to Wales.
The campaign includes two financial incentive schemes for doctors, one of which offers a £20,000 incentive to GP trainees taking up posts in specified areas such as Ceredigion, North Wales and Pembrokeshire which tend to have low fill rates.
It also offers a one-off payment to all GP trainees to cover the cost of one sitting of their final exams. Incentives will continue to be available in 2019.
The Welsh Government said since the launch of Train, Work, Live, there has been a “significant” increase in the number of GP training places filled.
Health Secretary Vaughan Gething said: “Train, Work, Live is one of our flagship campaigns and I’ve been delighted with what it has achieved so far. I am keen we continue to build on its success to ensure Wales has the medical workforce needed not only now, but in the future as well.”