Nhs general practice has passed the point of no return

J Meirion Thomas 31 August 2022 6:00pm BST This week, there was further bad news about GP services. Since 2013, 474 practices have closed permanently, affecting 1.5 million patients. This

has happened because GPs have retired or resigned and there are none to fill the gaps. Clearly, the health needs of some patients will be compromised, especially in deprived or

geographically isolated areas. Has NHS general practice, as presently configured, reached the point of no return? The difficulty in accessing appointments has resulted in a groundswell of

discontent, loss of trust and disastrous stories that can no longer be ignored. The main stakeholders, namely the British Medical Association, the Royal College of General Practice and the

Department of Health and Social Care, must stop pretending. The minor changes that they are making, presented as a cure, are nothing more than shifting the deckchairs on the Titanic. It was

the Labour government in 2004 that dealt the fatal blow. Its general practice contract change, negotiated with the BMA, meant that GPs had clinical responsibility for their patients only

during weekday office hours. In retrospect, the logic for that change is inexplicable given that GPs would have no contractual obligations for urgent care in the evenings or at weekends.

Inevitably, the pressure fell on A&E departments, a burden which was entirely predictable. Despite this reduced workload, the slippery slope into part-time working became the rule rather

than the exception. Now, 57 per cent of GPs work three days per week or less. They can do this because they are independent contractors to the NHS. This work pattern would not be allowed in

any other profession and must be challenged. GPs should be employed by the NHS with a job description and fixed commitments just like hospital doctors. Part-time working should be

restricted. The dependence on locum doctors must be reduced. Will there ever be a health secretary brave enough to enforce these changes? Do patients realise that these are the reasons why

they cannot access GP appointments easily and why they cannot receive continuity of care, the service they most value? There is evidence that patients who see the same GP regularly live

longer. Is that so surprising? With regard to cancer, survival rates in the UK lag behind almost all comparable high-income countries. Recent research has shown that 37 per cent of patients

with cancer in the UK present in A&E with acute symptoms and with advanced disease associated with a poor prognosis. Many cancers present with non-specific symptoms and can only be

identified by the intuition and skill of a GP. Here, continuity of care is crucial. A GP who knows the patient well may spot a change in appearance or attitude. The clue may only be found on

clinical examination, and this is where telephone or virtual consultation can fail so badly even if it is seen by some as an example of technological advance in health care. Ultimately,

solutions to the crisis in general practice can only be discussed when the stakeholders agree that our GP system is irrevocably broken. Then we can look for solutions to countries – such as

Australia, and parts of Western Europe – where primary care works far better.  ------------------------- _J Meirion Thomas is a consultant surgeon_