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GP WORKFORCE

By David Love
Contact the author via Chris Johnstone by e-mail at christopher.johnstone@ntlworld.com

Workforce planning for GPs has been a vital issue which has been ducked over many years by the Scottish Executive. You may remember Susan Deacon's Health White Paper, which committed the SE to increase consultant numbers by 600 to meet the needs of NHS Scotland in the years ahead. Despite the fact that there was a policy intention to shift health care from hospitals to the community, there was no recognition of the obvious need to increase GP numbers. Our protests were met with the response that there were too many unknowns to enable SEHD to quantify any required increase GP numbers. However these "unknowns" as far as they could be identified, applied equally to consultant numbers but mysteriously did not prevent a target being set for them!

SGPC and RCGP Scotland have at every opportunity pressed, with little success, for official recognition that Scotland will require more GPs in future and that planning and expanding training places should have happened long before now.

A minor breakthrough was made in "Securing Future Practice" in 2004. The group chaired by Sir John Temple, recommended in the text of the Report

"that there is an urgent need to increase the numbers of general practitioners and plan their numbers across Scotland".

However somewhat mysteriously this was subtly altered (by whom I know not!) in the summary of recommendations to read

"increase the number of general practitioners. There is also an urgent need to plan GP numbers across Scotland"

However SEHD's response to the report stated "The Scottish Executive accepts that GP numbers will have to increase" - definitely more positive than anything we had heard before on this issue, so I looked forward to discover how the SE was going to quantify that need. Needless to say, rather than actually doing anything to increase GP numbers, the SE embarked on yet another workforce planning exercise.

You will be forgiven for not having noticed the publication of the Scottish Health Workforce Planning Framework a few weeks ago. The report was quietly slipped out with virtually no publicity - astonishing for such a vital piece of work! Nonetheless I looked eagerly to see what the plan was to increase GP numbers in line with the SE's previous commitment. Whereas the section on Consultants contains a wealth of data by specialty and reaffirms the commitment to increasing consultant numbers by 600, the section in GPs is hugely disappointing.

The whole section on GP numbers seems to build on the obfuscations which have surrounded the determining of future GP numbers which we have had to listen to for the last 5 years or so. From my increasingly paranoid perspective, the report seems to adhere to a pre-determined agenda which refuses to acknowledge that there is a pressing need to plan to increase GP numbers now, and that there is really no need to increase GP numbers in the years ahead.

Both RCGP Scotland and SGPC had submitted a variety of compelling reasons why GP numbers will have to increase in the near future. These include the continuing shift of care from hospital to the community, the impending retirement boom, feminisation of the workforce and increase in part time working, increasing non-clinical work eg participation in CHPs, the increasing need for GPWSIs etc etc. These arguments are generally "parked" as they would say in current management jargon. The excuses we have been hearing for years for being unable to determine the future need for GPs are trotted out. You have heard many of them before - much of the new work which is planned to be transferred from hospitals will be done by other health professionals and not GPs. Great play is made of the unknown contribution of sessional GPs and this provides another great excuse for doing nothing, and recommending that more work needs to be done before any planning for future GP numbers can be made.

Some downright spurious reasons for not needing more GPs are advanced. For example, the report states that because the projected increase in patient contacts as a result of our ageing population exceeds the historic (pathetic) rate of increase in GP numbers the conclusion is drawn that we will not need any more GPs to cope with the needs of our ageing population. It is interesting to note that in other parts of the UK there is a clear acceptance that our ageing population will require more GPs to look after them in future.

The report claims that GPR numbers were increased from 250 to 280 from 2003/4 to 2005/6, as though this was a great gesture by the Executive to increase GP numbers! The reality of course was that GPR numbers used to be around 330 in 1990. This was reduced to around 280 when recruitment collapsed in the 1990s. There was a move to reduce this further to 250 but following protests from the profession this decision was reversed and funding for 280 places restored

The final conclusion of the report is really no conclusion other than a better evidence base must be built before any increase in GP numbers can be contemplated, or any action taken. We are left with a series of excuses which enable the SE to avoid grasping the nettle of actually doing something to increase GP numbers.

However the report advances a hugely comforting thought about GP numbers. If the prognostications in the report turn out to be wrong and the lack of action to increase GP numbers causes the whole thing to go belly up, don't panic, there is no need to worry. Why? It's all OK you see because it only takes three years to train a GP in comparison with hospital specialty training and so there really isn't any need to take action now to head off impending disaster - just wait until it happens and it will only take three years to sort it out!! No mention of course about there being the capacity to suddenly expand training numbers, whether we have enough Training Practices or whether they have adequate premises in which to accommodate additional GPRs as the service collapses around us.

With my trade union hat on maybe I shouldn't be agitating about increasing GP numbers. After all commodities in short supply tend to be expensive, and scarcity would strengthen our negotiating position. However I do care about the quality of service GPs deliver, and shortages of GPs can only be bad for patients and indeed for GPs themselves.

Rather more selfishly when I cease to be a GP and join the ranks of elderly patients in the not too distant future, I would like to be sure that I will have a nice caring GP to look after me. Not whatever nightmarish alternative to GP care I fear the Scottish Executive might secretly be planning!

Other hoolet online articles by David Love can be found at:
hoolet edition 47 - GP Workforce

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.