Notes for a profession in difficulty

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Lara Shemtob¹  Johannes Driessen²  Alice Howe³  Adam Harvey-Sullivan⁴  Martha Martin⁵ 

[1]Imperial College London

[2]Johannes is an academic clinical fellow in general practice at King’s College London, with a special interest in clinical education.

[3]Alice is an academic clinical fellow in general practice at Queen Mary University London, with a special interest in equality, diversity, and inclusion, and women’s health.

[4]Adam is an academic clinical fellow in general practice at Queen Mary University London, with a special interest in health inequity.

[5]Martha is an academic clinical fellow in general practice at Imperial College London, with a special interest in digital health and integrated care systems.

DOI  :  10.3399/bjgp23X733041

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

IS IT ME, OR IS IT GENERAL PRACTICE? As academic clinical fellows (ACFs) in general practices across London we are stakeholders in general practice at the outset of our careers. We recently discussed our concerns about the future of general practice and our futures in the speciality at our regional teaching session. Here is a summary of what we discussed:Some GPs have up to 70 patient contacts per day. On average, GPs deliver 50% more than the British Medical Association’s (BMA’s) safe limit of 25 patient contacts per day.A substantial proportion of appointments last over 10 minutes. In some months, around 20% of appointments delivered lasted more than 20 minutes.The number of appointments being delivered in general practice month to month is more than the speciality is resourced for. In February 2023, 27.3 m appointments were booked, almost 2 m more than in February 2022. A total of 44% of appointments in February 2023 were booked to take place the same day, while 85% were booked to take place in the next 2 weeks.The job can be emotionally and physically demanding to the extent it is common to feel that working as a full-time GP would be unsustainable. This can create internal conflict, confusion, and self-doubt … surely 10 sessions of clinical general practice should be doable? Many of us have asked the question ‘Is it me, or is it general practice?’There has been a steady decline in the number of full-time equivalent qualified GPs in England over the past 5 years, yet 80% of GP’s work exceeds over 35 hours per week. Colleagues restrict their clinical sessions to try to contain workload, which still equates to full-time hours.The amount of non-patient facing work (up to 40% of workload) is increasing and GPs are working an average of up to 46% extra unpaid hours in order to get all of their work done.There is a recruitment and retention crisis; the target of 5000 more GPs by 2020 set in 2016 is long gone, and we are moving further away from the 2019 target of 6000 more GPs by March 2024.The most recent national GP worklife survey showed that overall satisfaction with the job has decreased from 2019 to 2021, and over a third (33.4%) of GPs indicated that they may leave patient-facing work in the next 5 years (rising to 60.5% in the over 50’s).The number of patients registered at GP surgeries has increased in the same timeframe. People living in the most deprived areas have fewer GPs per person than those living in the least deprived areas, which relates to the inverse care law.The staffing deficit is pervasive across health and social care but general practice is a particularly hard-hit specialty. While the number of GPs is falling, the numbers of hospital doctors and consultants are increasing. Yet, as much as 90% of health care is delivered in primary care for <10% of the department of health and social care’s budget.

【 授权许可】

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