GPs are the overlooked crisis in the Health Service. If we fail, so does the NHS

Tom Holdsworth

General practitioners like me save hospitals from being overrun. But years of underfunding have led to a chronic shortage

Tom Holdsworth is a GP and clinical director of a primary care network in Sheffield

In summer 2020 I had been working at the same GP practice for 10 years and had seen the workload increase steadily. Each Monday morning I would start at 8am to get through the list of 50 phone calls and to see those needing urgent face-to-face review. I would finish my morning list just before 3pm and start my afternoon surgery 10 minutes later. At 6pm I would start looking at paperwork and around 8pm I would leave for home with the day’s work unfinished. Despite a 12-hour shift, it still felt as though the job was only half done.

For a long time, the Sunday evening dread had been arriving earlier in the weekend. On a Saturday in June last year I was due to go with my family to the park for my son’s birthday, but all was not well. Choking with emotion, I muttered some excuses and disappeared to work my way through the backlog of emails and blood results. That’s when it hit me: things were so bad, I couldn’t even be there for my son’s birthday on a day off. A few months later I walked away from the practice, to the sadness of many patients and the great distress of my GP partners.

There were complex issues at play, but the bottom line is there are not enough GPs. In 2015 the NHS Five Year Forward View promised a better health service and recognised that this would need 5,000 more GPs by 2020. However, by March 2021 there were 1,307 fewer GPs than in 2015. Things are now so bad with the GP workforce that the King’s Fund last year described a profession “in crisis because of difficulties in recruiting and retaining GPs alongside a growing and increasingly complex workload”.

When the NHS long-term plan launched in 2019, prior to the pandemic, it committed additional funding for the health service but this was against a backdrop of a long period of inadequate investment: health spending at the time was at its lowest in a decade as a proportion of GDP. The proportion of money being spent in general practice had also fallen, from around 9.6% of the overall NHS budget in 2005/6 to 8.1% in 2017. By 2019, practices were struggling to manage patient demand.

As well as underfunding in primary care, cuts to services that tackle the underlying causes of ill health have come as a double blow. The effects of this are particularly acute in general practice, due to GPs’ role in dealing with chronic disease, frailty, and the complex crossover between physical health, mental health and social need. Public health spend is now 22% lower than it was in 2015/16 and social care is in the midst of an even worse crisis: the recently announced increase in social care funding will in effect provide only an average of £1bn per year in the immediate future. Clearly this is not the fix our care system so desperately needs.

GPs are the bedrock of the NHS, and if general practice fails, the NHS fails. General practitioners often know their patients well and can bring the power of these relationships, which may stretch across decades, to solve problems that other professionals cannot. GPs are our expert risk managers and our expert communicators. They protect the hospitals from being overwhelmed as they deal with most patient needs for a fraction of the NHS budget.

And yet for all this they are persistently undervalued across the system: from the university lecturer telling me, “Work hard or you’ll end up as a GP”; to the A&E consultant who told me, “The GP gravy train can’t last for ever”; to the failure to recognise GPs as specialists in primary care on the UK specialist register. A fraction of research budgets are spent in general practice, leaving GPs to provide care as best they can with an evidence base that is incomplete.

While the healthcare system seems to undervalue the contribution of its own foundation layer, the public response over recent months has been one of increasing anger, fanned by newspaper headlines about pay and face-to-face appointments. Political leaders, rather than lending support, have opted to squeeze us from either side. It can leave GPs feeling like they are living under siege. Increasingly on social media you can see the frustration of the situation boiling over in skirmishes between GPs and hospital doctors, MPs and the press.

New funding was promised for the NHS last week but there needs to be honesty about what it will achieve. The extra cash does not address the problems of the past decade or the chronic workforce shortages. Funding to reduce hospital waiting times is needed but will not provide general practice with real solutions or offer the hope it desperately needs. Without hope we will not attract fresh young GPs, and we will not retain old experienced hands. And without GPs the foundation of our NHS will crack and crumble.

Our common bond is that we are all potential patients, whether we happen to work as an electrician, a teacher, a nurse, a GP or a cardiologist. We deserve better, and together we need to ask our leaders to properly plan and fund a health and care system that stops us getting sick by looking after our wellbeing, that looks after us when we are ill, and cares for us when we can’t look after ourselves any more.