Even funding the NHS properly won't solve all the problems caused by austerity
Jaimie Kaffash, editor of GP magazine Pulse, believes years of austerity has caused the NHS to collapse
by: Jaimie Kaffash
10 Jan 2023
As demand outstrips supply, Jaimie Kaffash says burnt out GPs are leaving the profession. Illustration: Álvaro Bernis
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‘GPs will be named and shamed over failure to see patients face to face’. ‘League tables laid bare how few GPs see patients face to face’. ‘Pets have more of a chance of getting treatment within hours than their owners booking same-day GP appointments’.
Rarely a day goes by without another headline criticising GPs in the national press. The criticisms are varied, and often contradictory; they get criticised for long waiting lists but also for failing to provide enough face-to-face appointments, which take longer than phone or video consultations, therefore increasing waiting times. They get criticised for giving too many antibiotics, thus contributing to antimicrobial resistance, but also for failing to give antibiotics to patients who request them.
It’s not just the press. In England, the government and the NHS is just as hard line. Various health secretaries have delighted in the idea of naming and shaming poorly performing GP practices, and have introduced increasingly impossible targets, without any financial support to follow. Labour seem to be happy to continue such rhetoric, with shadow health secretary Wes Streeting saying the “something for nothing culture has to end” in general practice.
Such criticism has its harms. We very rarely used to see abuse directed towards GPs but now we run stories about violence towards doctors and their staff on a weekly basis.
Patients have every right to be upset at the state of general practice – and GPs themselves are more upset than anyone. It is unacceptable that patients have to wait for weeks, or that they are unable to even get in contact with their practice, or that they can only get an appointment with a non-medically qualified member of staff.
Yet this is not through the lack of effort from GPs or their staff. In 2021, when Pulse asked 1,400 GPs about their workload on a single day, we revealed they were working 11-hour days on average. Around half said they were providing unsafe care. Since then, things have got much worse across the NHS. When we do our next workload survey, I can say with certainty the results will be even more frightening.
And don’t be fooled by statistics around GPs being predominantly part time; in general practice, this normally means a 40-hour week spread over three days or similar. I wouldn’t advise being the last patient at the end of a 13-hour shift.
The fact is, demand is outstripping supply by some distance. The population is living longer but, as a result, is older and in more need of healthcare.
At the same time, austerity across all public services has increased demand on general practice, which is the first port of call for many who have nowhere else to turn. The decimation of social care budgets is the most obvious factor. But there are others: cuts to local government spending has seen the end of many public health programmes, including substance misuse and sexual health clinics. Even cuts to social housing causes medical problems, most tragically seen in the case of 2-year-old Awaab Ishak, who died in 2020 as a direct result of black mould in his flat.
But the even bigger issue is supply. In 2015, then health secretary Jeremy Hunt promised to increase the number of full-time equivalent GPs in the workforce by 5,000 by 2020. Between September 2015 and November 2022, we have lost 1,972 full-time equivalent (FTE) GPs. They are understandably leaving the profession, sick of being demonised in the media and by the government despite working to the point of burnout. And every recruitment initiative has failed miserably.
(As a side note, as health secretary, Mr Hunt did very little to help GPs. After leaving the role, he had a Damascene conversion, becoming a champion for general practice. Now he has the power again to do something as chancellor, he has become strangely quiet.)
Funding is obviously an element to the crisis in general practice. Despite the government’s protestations, it had reduced real-terms funding for general practice on an annual basis post 2010. Only in the past few years has it provided funding in line with inflation, and only just.
Chucking funding towards general practice and the NHS in general will help, of course. It might build hospitals, GP practices and provide existing staff with the pay rises they deserve. The striking nurses and ambulance staff – and potentially junior doctors – generally have the support of GPs, many of whom wish the BMA’s GP Committee takes similar action.
But while funding might enable the pay rises that will retain some staff, it won’t cure all the ills caused by years of austerity across the board. It won’t overnight magic up GPs, consultants, nurses and all the other people who are needed to staff any shiny new buildings.
In many of my editorials, I have pondered the concept of the NHS collapsing. Ask me 10 years ago, and I would have defined a collapse of the NHS as being GP practices closing in droves, patients simply unable to get through to their GP, ambulances queuing up for A&E, 48-hour waits for the emergency services, two-year waiting lists for hospital operations and an unhappy workforce that was having to regularly strike. Welcome to the NHS in 2023.
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