The State of Medical Education and Practice in the UK 2014 reveals that the number of applications dropped from 6031 in 2013 to 5100 in 2014 with “considerable variation in the supply of trained GPs across different parts of the UK.” The GMC adds that the burnout being felt by the current GP workforce may have contributed to the fall in applications to join general practice with Health Education England in July taking the unprecedented step of opening general practice recruitment for a third round of applications. It also highlights the increase in the number of doctors coming from the European Union to work in the UK with the total number of doctors coming to Britain from overseas increasing 8% from 5,204 in 2008 to 5,619 in 2013. Of these, in 2008, 18% were from southern Europe and 28% from South Asia; this changed to 33% from southern Europe and 20% from South Asia in 2013.
At the RCGP 2014 Conference, the Secretary of State announced plans to commission an independent review to determine how many additional GPs are required and in which areas of the country after fully acknowledging the current pressures on general practice and primary care which include: the complete re-structuring of the NHS; an ageing population with increasing numbers of conditions requiring long-term management and the endless diatribe from Government and some of the media about the financial greed, poor quality and unavailability of/access to all GPs. And why would we want just a single independent review – when these are metrics that require constant attention and feeding into larger simulation/scenario-planning models that would enable the ‘constant gardening’ that’s required to run any efficient organisation or perhaps this is something that the Centre for Workforce Intelligence is there for? It will be interesting to see who gets the commission?
It was very clear that GPs at the Conference perceived themselves to be, and are by many measures, under unsustainable pressure right now and, as they say – especially when we are highly stressed – “our perception is our reality”. The report highlights that rising demand is not the only issue and Action for NHS Wellbeing champions the need to skill and ‘wise-up’ doctors as an essential resilience-provision and preparation for working in the ‘real’ NHS. The Chair of the RCGP highlighted the issue of more GPs now taking early retirement and/or heading off to work overseas and there were a number of stands at the Conference seeking to recruit them.
The report also highlights the regional variation in take-up of training places: this was as low as 62% in the East Midlands, compared with 98% in Northern Ireland, 89% in Scotland, and 90% in Wales. “There were differences between rural and urban areas, but there were common themes with concerns about being overloaded and some GPs being at risk of burning out.”
It is totally unacceptable that we have these regular workforce heave-ho’s – most of which result from the party politicization of the NHS and the fact that it is hitched to a short-term, oppositional and frequently toxic egosystem. The need for politicians to be voted into Parliament and all that goes with that – not having open discussion both locally and nationally about the required onward ‘tuning’ of health and social care services; creating contexts of blame, fear and over-managerialism that result in risk-aversion and paralysis – as opposed to the worthy rhetoric about ‘innovation’; enabling increasing corporatisation and privatisation and threats to the data about our healthcare by the back-door/stealth whilst we are all kept frantically busy with our work and numerous ‘consultation’ exercises or are away on holiday – are all symptomatic of world in which military dictatorships are being replaced by corporate ones (Seager – personal communication) and powerful oligarchs who have more money, power and connections than many Governments.
The world is no longer confined to Runcorn-by-Bow Health Centre, Feltham-under-Duvet Community Health Trust or St Elsewhere’s International Foundation Trust Healthcare TTIP. Trained to spot a phaeochromocytoma from 500 metres, many are ill-prepared for the ‘real’ NHS and its myriad people and their tens of millions of consultations- many of which concern far more common ailments, great distress and the outfall conditions of life such as depression, alcohol dependency, self-harming, substance misuse, obesity and medically-unexplained symptoms ( most of which are entirely understandable, if not yet entirely explicable).
What a damning indictment that, in a self-claiming and so-called “first world developed country” we can still take highly motivated people with smiles on their faces and turn so many of them into miserable, dreary, defeated and burnt-out drones; deploying our running feet is a proven personal survival measure under such circumstances.