Because ministers have missed their target to recruit 6,000 new GPs in England by a wide margin, they have now produced a set of fixes designed to relieve pressure on general practice by directing people elsewhere. These changes will extend the orbit of primary care to pharmacists and even receptionists, ensuring, according to the NHS chief executive, Amanda Pritchard, that “patients won’t need to go to a GP unless they really need to see a GP”. The plan seems motivated more by a concern for cost than health outcomes. Rather than addressing the causes of this crisis, it will triage and divert patients to other parts of the system.
Not all the ideas in this plan are without merit. Making it easier for people to access their medical records is practical. In theory, giving pharmacies £645m over the course of two years to prescribe treatments for common illnesses makes sense. In practice, this proposal doesn’t account for the shrinking number of community chemists, or the sector’s staff shortages. Allowing pharmacies to prescribe antibiotics when our health depends on using them prudently could pose risks. And if pharmacies are to do more of the work of family doctors, standards should be benchmarked and inspections conducted more regularly to ensure all patients receive good quality care.
Other parts of the government’s plan seem more like transparent attempts to ration access to GP appointments, whose scarcity is a product of political failure. Training receptionists to clinically assess people over the phone may deepen the feeling of frustration among patients who may find themselves having to share their medical information with non-clinical staff. Investment in better telephone systems for surgeries is welcome, but it is no replacement for more GPs. Pretending that such measures will solve the “8am rush” looks like either wilful ignorance or cynical deflection. The problem is not a lack of phones or trained receptionists, but the lack of doctors.
England has lost almost 2,000 qualified full-time GPs since 2015. One in five plan to quit within five years. This exodus has left a depleted, burnt-out workforce to deal with the growing demands of an ageing and unwell population. The creeping burden of administration, lack of time with patients and an unmanageable workload (some GPs are now taking as many as 90 consultations each day) are forcing qualified doctors to leave and deterring young medics from joining practices. Given these problems, it is incredible that the government has not yet produced a fully funded NHS workforce plan.
Now is a good moment for a creative rethink about the future of primary care. It will become even more important as the population ages and people live longer with chronic conditions. There have been numerous attempts to create more integrated healthcare in neighbourhoods, such as the handful of polyclinics pioneered by New Labour, which gave patients access to a variety of services. The Conservatives’ introduction of primary care networks was a recognition of the need for a more integrated service. But forcing GP practices to reshuffle the cards when they don’t have enough doctors, and when only 8% of health spending goes on primary care, is bound to be ineffective.
Ministers recognise that the sector is in crisis. Solving this must start with retaining existing doctors and recruiting many more, ensuring patients get continuity of care as well as just access to medicines. Yet the government is trying to deliver solutions on the cheap.