Just days before the beginning of the new academic year, the Department of Health announced that almost 20 per cent of GP training places in Northern Ireland had not been filled. This is a worrying, yet not surprising development.
Twenty years ago, a GP was a highly respected professional. A pillar of the local community. The family doctor-patient relationship was one of the most valued and trusted in health care.
These professionals are unique in that they provide advice and care at every stage of your life, from the time you are born, the birth of your children and helping you to care for your ageing parents. Sharing your struggles and triumphs and advocating for you through the labyrinth healthcare system, explaining options and likely outcomes.
Often at your side at the most significant milestones in your life, GPs are both the backbone and the frontline of the NHS. They are the first port of call for most ailments or medical-related queries.
Even though the road to this profession is both long and arduous, traditionally training programmes have been extremely popular and highly competitive.
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Today GP training is undersubscribed with unfilled places. What has changed? Why are medical students opting for other roles and turning their backs on what was once viewed as a safe and rewarding career?
This development has serious consequences for the pipeline of GPs and the future of patient care. Urgent action is required to overhaul the primary care system and make it fit for purpose.
Against a backdrop of a growing and ageing population with complex health needs, a quick fix cannot address fundamental problems.
Firstly, there are not enough GPs to cope with growing demands. We are already hundreds of GPs short of the number we need and many currently in the system are demoralised and exhausted.
Yes, of course, the public are frustrated and angry when they cannot access their local practices. Radio phone-ins and newspapers regularly feature stories of people who cannot get through to their doctors to secure an appointment and are waiting for weeks to be seen.
Naturally people worry when they or their loved ones are unwell and they face an unresponsive system. GPs are the gatekeepers to the vast majority of NHS services and are needed to signpost patients to the most appropriate options.
However, rather than empathising with those delivering services in very trying circumstances, many sections of the media have chosen instead to bash them. Criticising working hours, workloads and questioning their work ethic.
The right-wing press in the UK have been publishing incendiary articles for years alleging GPs were overpaid and underworked. During Covid these attacks intensified with articles screaming that “Now GPs want to work even less!”.
In a plethora of mud-slinging attacks, they have been described as idle, greedy, denying patients appointments and choosing to work part-time to spend more time on the golf course.
The myth that no face-to-face consultations took place during Covid was repeated ad nauseam. Contrary to popular belief, most practices remained open.
Flexibility and innovation through the use of online and remote appointments was described as substandard and derided as a way to fob off patients. Unsurprisingly, the cumulative effect of this has been damaging to the profession and undermined public trust and confidence.
Figures from the RCGP show that 4 in 10 GPs are already planning to quit general practice in the next five years due to chronic workload and workforce pressures. Unfair scrutiny and attacks will only make this worse.
The root cause of this crisis is over a decade of underinvestment and a GP workforce not big enough to meet demands that are growing exponentially. We should be training more doctors.
In 2021 the OECD reported that the UK has among the fewest doctors and nurses per 1,000 people across Europe. Numbers of full-time equivalent qualified GPs have not increased since 2015 and indeed more recently have fallen.
The numbers leaving the profession are higher than people are entering GP training and, thanks to Brexit, fewer international medical graduates now come to the UK. However, annual recorded GP consultations are at record highs.
These professionals routinely work beyond their contracted hours with follow-ups, administration, training and other related activities. Leaving surgeries hours after “the working day” is over is just accepted as part and parcel of the job.
The vilification of this workforce is indefensible, demoralising and must stop. Rather than demonising those that provide this essential service we should be supporting their calls for additional support and investment.
The relentless nature of seeing too many patients in limited time slots has taken its toll physically and mentally. GPs are responsible for 90 per cent of patient consultations in the NHS yet are allocated less than 10 per cent of NHS budgets. The shortage of staff has placed enormous strain on the profession.
In Northern Ireland the record numbers of people on waiting lists for elective care has increased the burden on GPs. Patients waiting on operations go to their GP in despair, desperately wanting answers and respite from increasing pain and discomfort.
We have the highest rates of poor mental health in the UK. The glaring gaps in mental health services means increasing numbers are turning to GPs with psychological distress, low mood, anxiety, as well as a mixture of personal, relationship and financial concerns.
It is time to correct the narrative, boost morale and ensure that becoming a GP is a viable, sustainable and an attractive option for medical students. Provide opportunities for GPs to develop specialisms and facilitate research opportunities.
In my experience people opt for medicine because they want to make a difference, but this constant denigration makes the job of a GP unattractive and untenable. There are other ‘easier” options.
This GP crisis is not going to go away, and we are in a precarious place. Unless this situation is addressed things will only get worse. It is essential that these professionals are represented fairly.
They want to deliver the high-quality care that people rightly expect but this cannot and must not come at the cost of jeopardising their own wellbeing.
Without urgent action to stop the exodus, address the underfunding, encourage medics into this career, the NHS as we know it will no longer exist.
