Step in the right direction

Dr Shire said: “The increase in GP employment levels is very welcome, and a step in the right direction. “Making ARRS funding available for GPs has been a helpful part of that. “However, it is still restricted by the government-imposed red tape, which limits the ARRS GP role to newly qualified practitioners. “This is of concern as Primary Care Network (PCN) ARRS roles are based across multiple practices. “This can lead to isolation, a lack of direct support, and difficulties with continuity and follow ups. “All of these are a vital part of being a GP, and even more important for newly-qualified GPs.

Qualified GPs

“And it also doesn’t help with jobs for GPs who qualified more than two years ago. “Ultimately, the 1,500 figure is actually only 851 FTE GPs, and still leaves us more than 1,000 FTE GPs shorter than in 2015.” DAUK GP committee members were speaking after the Government announced an extra 1,503 GPs have been recruited since 1 October. Health secretary Wes Streeting said: “By cutting red tape and investing more in our NHS, we have put an extra 1,503 GPs into general practice to deliver more appointments. “The extra investment and reforms we have made will allow patients to book appointments more easily, to help bring back the family doctor and end the 8am scramble.

National Insurance increase

“It is only because of the necessary decisions we took to increase employer National Insurance that we are able to recruit more GPs and deliver better services for patients.” However, Dr Shire said the rise in National Insurance for general practice was taking money away. She said: “A large portion of the extra money the Government announced is going back to the Treasury and away from practices and their patients in National Insurance hikes.” Dr Ellen Welch, DAUK vice chair and a GP in Cumbria, said it was welcome news that GP numbers were up. She added: “It’s something we can build on.

Out of work GPs

“But there are still lots of GPs who are out of work or short of work, which is a scandal at a time when we’re crying out for GPs. “DAUK continues to call for practices to be able to use the ARRS funding in the best way for them, without the current red tape that prevents them from employing experienced GPs.” Dr Steve Taylor, DAUK GP spokesperson, said: “It’s good that GP numbers are up, but there is still some way to go to reach the targets of required GP numbers, which were projected 10 years ago. “We’re still 7,000 short of that number and only making ARRS funding open to GPs up to two years post their CCT is not ideal, to say the least. “Although numbers of fully employed GPs are up, there has been a similar fall in the partly employed ad-hoc locum numbers which means overall access to GPs for patients hasn’t increased significantly.” Please support our work by contributing to our crowd funder or by becoming a member.

Dr Toberty told national radio listeners that the government needed to invest in public health to improve the health of the nation and prevent people getting unwell.

Speaking on Nick Ferrari’s breakfast time programme on LBC, Dr Toberty said: “We need to look at public health and the reasons why we are unwell and getting unwell.

“The public health budget has been slashed by about a third in real terms since 2010.

“We need to urgently look at and try to improve the health of our nation proactively and not just wait until people are getting unwell.”

Dr Toberty was commenting on the latest NHS referral to treatment figures for June 2024 show that the waiting list stood at 7.6 million cases, with an estimated 6.4 million patients.

Among the 7.6 million, in 302,693 cases the patient was waiting more than 52 weeks, the NHS said.

In 58,024 cases they were waiting more than 65 weeks, in 2,621 cases they were waiting more than 78 weeks, and in 120 cases they were waiting more than 104 weeks.

In 58.9 per cent of cases the patient had been waiting up to 18 weeks, missing the target of 92 per cent.

Dr Toberty told national radio listeners that she was not surprised by the figures.

Waiting lists

“As a nation we are unhealthy and sick,” she said.

“There are one in nine of us waiting for treatment at the moment, and I don’t think there are any quick fixes.

“I know about the suffering and the difficulties our patients are having, and not just the patients but their families and their carers around them.

“When we have these problems, it starts to put pressure on the rest of the health service because a problem initially then creates problems with pain and depression and other things.

“People have to go somewhere with those issues so you can see how things quickly escalate.

“I’m glad this is a top priority for the government, and it needs to be.

“If we can bring waiting lists down I am convinced we will reduce some of the pressures on the acute parts of our services.”

Dr Toberty said the government should look at investment in the NHS as an investment in the wider economy.

“This needs investment,” she said “They need to pay overtime, and we need to get this down.

“This is an investment in our health service, in our economy, in getting us well and back on our feet again.”

Listen again to Dr Toberty’s interview on the DAUK page on X.

Become a member of DAUK and support our work.

Speaking on national radio, Dr Taylor, GP spokesperson for the Doctors’ Association UK, said the collective action voted for by family doctors was about their safety and that of patients.

He said by taking collective action GPs were working to their contract and that they were ‘not stopping work, downing tools, or walking away from patients’.

Dr Taylor said: “Over the past 30 years we have added and added to the workloads that GPs do, and this is a case of working to contract.

“Since 2019 we are doing 20 per cent more appointments than we were before the pandemic.

“We’ve increased the number of appointments, and that includes face-to-face appointments, telephone appointments, e-consults, the number of prescriptions.

“In the context of what’s going on, it’s GPs saying hang on a second, ‘we can’t do this anymore’.

Patient care

“This is about providing for patients.

“It’s saying we can’t carry on doing all the things we’ve been asked to do in addition to caring for patients,” he added.

Dr Taylor was speaking on the Vanessa Feltz programme on LBC, and told listeners about some of the issues that are placing increasing demand on GPs.

“One in nine patients are currently waiting for hospital treatment, and those one in nine patients aren’t waiting passively,” he said.

“They’re coming to see GPs, asking us to write letters and sometimes they’re ill with pain.

“We’re having to deal with a lot of people who, ten years ago, would’ve been dealt with a lot more quickly by the hospitals.

“Another example is a number of the proformas we’ve been asked to fill out take a lot longer than old fashioned referral letter.

“We used to write to our colleagues at the hospital and say can you see x, because they’ve got y and can you exclude z?

“Now we have to fill out a proforma which can take five or six minutes to do.

Cuts to funding

“It doesn’t sound like much but in the context of providing a 10 or 15-minute appointment, that’s half an appointment when it used to take a minute to write a letter.

“It’s all added bits of work as time has gone on.

“30 years ago, my average working day was about eight to eight and a half hours. It’s gone up to 10 to 11.

“The number of appointments I was doing back then was 27 a day, it went up as high as 50 at some points, a mixture of face-to-face, telephone and e-consults.

“In addition to that, the funding has been cut. We’ve got 20 per cent less funding per patient than we had even eight years ago.

“It means we have fewer doctors and nurses in practices.

“The average number of patients a GP looked after was 1,800. It’s now 2,300.

“If we had more money we could employ more doctors.

“There isn’t a shortage of doctors, we’re producing 4,000 doctors a year through the training programmes, but we’re now in a position where many of those can’t get the amount of work that they want – and some are unemployed.

“It’s crazy.”

Collective action

Dr Taylor emphasised that the collective action was ‘not about pay’.

He told LBC listeners: “It’s about making sure patients get access to GPs.

“Every single day 1.4 million people have access to GP practices, which is huge numbers of people, and it was 1.2 million not that long ago.

“But we can’t carry on doing all of that. It’s not possible without the extra resources and extra funding being brought into practices.

“We care for patients. I wouldn’t have been a GP for 30 years if I didn’t genuinely care.

“We’ve done everything we can possibly do with the resources we have. We basically pleading for more.”

Become a member of DAUK and support our work.

The GP lead for the Doctors’ Association UK (DAUK), Dr Toberty warned the two per cent annual contract uplift offered by NHS England was ‘not enough to sustain the services patients need’ and that practices will go under.

Dr Toberty said that if funding of general practice continued in the same way, ‘there will not be enough GPs left’.

Writing for Metro, Dr Toberty said she and her DAUK colleagues supported the collective action voted on this week by GPs and explained reasons behind it.

She said: “Historically GPs have just plugged gaps in care, working above and beyond their contracts for free. NHS England and the last Government were repeatedly warned this was not sustainable.

“But our calls were ignored and therefore – rather than closing our doors and striking – we are aiming to work in a safe way and take care of our patients properly, while also demonstrating to the system the sheer amount of unfunded work we have been doing.”

Postcode lottery

Dr Toberty added: “Without these recently voted-on actions, we are hurtling towards a two-tier model similar to dentistry, where it will be a postcode lottery whether an NHS GP will be available for you at all.

“Unfortunately, we already have practices handing back contracts and going bankrupt at an alarming rate. This chaotic shambles is a nightmare for patients and leaves them confused as to where to turn when unwell.

“As a mum, daughter, and a GP, I’m terrified there may not help available for us when we need it.”

Read Dr Toberty’s column in Metro.

Her colleague on DAUK’s GP committee, Dr Steve Taylor, spoke on national radio about the collective action, describing it as ‘fundamentally about patient care’.

During an interview on Times Radio Breakfast, Dr Taylor said that general practice had been underfunded for the past 10 to 15 years, that GPs were doing more work than ever for less pay, and that the vote was a signal that something needed to change.

He said: “Fundamentally this is about patient care.

“We as GPs want to provide care for patients.

“For the last 14 years we haven’t had enough funding to make practices work.”

Listen again to Dr Taylor’s interview on Times Radio Breakfast, starting at 1:51:15.

The Prime Minister was speaking at general election rally in Wiltshire when a GP questioned him about changes to funding available to recruit staff.

The GP, understood to be Dr Jane Lees-Millais, said the NHS was ‘disintegrating’ and said that she was one of 2,500 GPs in the country currently unemployed because of the Government’s policies.

“The country is not stupid,” she said. “They know when lesser qualified people are being used to conduct consultations which are massively complex.”

Mr Sunak responded by saying his dad was a GP and mum a pharmacist, and that he understood primary care.

He said he was ‘making it easier for people to see other primary care practitioners to get the treatments they need’.

General practice funding

Dr Shire, of the Doctors’ Association UK GP committee,  told national radio listeners that GPs were not allowed to spend funds from the Government on hiring GPs or practice nurses.

Speaking to Vanessa Feltz on LBC, Dr Shire said: “There’s concern within general practice that the demand is increasing and yet we have 2,000 fewer GPs than we did in 2015.

“Although they are putting money into primary care, unfortunately, that money is ring-fenced so it can’t be used for GPs and practice nurses.

“It can only be used for other patient care roles, such as pharmacists or physios, which is great and they definitely play a part in primary care, but we have GPs coming through the system, they’re trained up, they want to work, and they can’t get jobs.

“We have patients who want to see GPs but they haven’t got that choice anymore.”

She said that allied healthcare professionals had an important part to play in Primary Care, but that GPs ‘trained for much longer and have that depth and breadth to see the person as a whole’.

“As people get older they’re going to have more health conditions and that then does cause more complexity,” Dr Shire said.

“Healthcare professionals who aren’t medically trained perhaps won’t be able to look at that as a whole and understand the depth of what might be going on.

“It’s having that picture as a whole and making sure people are seen by the right person, and a GP is able to look at that in one go.

“If people see a physician, that costs less than seeing a non-physician such as a patient care role that isn’t a GP or a nurse.”

Is the NHS broken?

Asked by Vanessa Feltz whether the NHS was ‘disintegrating’, Dr Shire said: “We’re worried it might be broken. It’s definitely not doing well at the moment.

“People are becoming more unwell. We have more people needing care.

 “If we can get people the healthcare they need earlier, we can get them back on their feet and working again.”

Dr Shire added: “I think a lot of GPs and a lot of doctors are starting to feel demoralised and dispirited.

“You train to become a doctor because you want to help people, you know what that person needs and you can’t give them that.

“That is really hard and I think we’re seeing more and more GPs burning out and struggling themselves.

“The services that support GPs and doctors with their mental health are struggling because we’re struggling ourselves.

“But we keep going back because you want to do what you can and you want to do your best.

“If you can’t do that, it doesn’t feel very nice.”

Become a DAUK member and support our work.

DAUK is holding a briefing for prospective MPs on Wednesday 19 June to discuss the crisis in general practice and things that could be done to tackle it.

The briefing, Why Can’t I See My GP? The Great British Paradox, is based on the book Why Can’t I See My GP?, a copy of which DAUK sent to all 650 MPs in March.

The briefing will be held members of DAUK’s GP committee, including its chair Dr Lizzie Toberty, past DAUK co-chair Dr Ellen Welch, and members Dr Steve Taylor and Dr Sarah Jacques.

DAUK is asking people to invite the candidates standing in their constituency to attend the briefing. Find out the candidates in your constituency at https://whocanivotefor.co.uk/

Find out more about the briefing.

The feature explores how medics are disproportionately likely to die by suicide and highlights the immense strain family doctors are working under.

Dr Sarah Jacques shares her personal story, which she hopes will amplify the growing issue of adverse mental health in the NHS workforce.

She said: “‘Medicine is a vocation. You don’t stop being a doctor, it’s so much a part of you and when you don’t feel you’re doing it well you feel worthless.”

Our former co-chair, Dr Ellen Welch, author of Why Can’t I See My GP?, talks about the reasons behind plummeting morale among GPs.

“People have gone overseas, for example to Australia, where the salary can be almost triple what it is here and doctors have more time with their patients,” said Dr Welch.

Dr Lizzie Toberty, our GP lead, discusses how workloads can be managed with better triaging.

She concluded: “I do get stressed because you are holding so much risk and responsibility, but because I work with great people and I know I’m supported I still enjoy it. It’s a great job.”

Read the feature on GPs in crisis.

Sign up to be a DAUK member and support our work.

Dr Taylor, GP spokesperson for the Doctors’ Association UK, was commenting after a debate on the BBC’s Question Time about so-called ‘sick note culture’.

The discussion included an acknowledgment by Wes Streeting, the Shadow Health Secretary, of the work load pressures facing GPs

Dr Taylor said: “We welcome Wes Streeting’s recognition of the increased workload for GPs, fewer practicing GPs and that they are not the problem for the so called ‘sick note’ culture.

“DAUK agrees with Mr Streeting that the issues are with patients waiting, with mental health services being under resourced, and with GP practices being overwhelmed with more work and fewer GPs.

“It’s important that GPs are fully involved in helping provide the solutions, listened to, and resourced to provide what is needed to support patient care.

“We don’t agree that GPs are ‘dishing out’ sick notes. GPs are often best placed to understand the full circumstances of a person sat before them or on the phone.

“Reform of sick notes could be an extension of self-certification, similar to during the pandemic, when it was extended to 28 days.

GP funding

“Ultimately GPs need resources not cuts, which currently is the experience of general practice. 

“And with a properly resourced primary care, we can do so much to prevent illness and do so much to help get people back into work.”

Mr Streeting set out how, if voted in at the next election, a Labour Government would tackle the crisis facing general practice.

“Of course GPs are having a real problem with their work load,” Mr Streeting said.

“If we want to sort this problem out then let’s deliver 2 million more appointments a year to cut NHS waiting lists.

Mental health support

Let’s have mental health support in every school. Let’s have mental health hubs in every community.

“Let’s double the number of scanners so we can diagnose earlier and treat faster.

“If we can get people treated and back on their feet we can get them back to work.”

Chris Philps, the Policing Minister, told the programme there were 850,000 more people on long-term sick since the pandemic.

Discussing plans announced by the Government this week to strip GPs of their power to sign people off and replace them with ‘specialist work and health professionals’, he was asked by host Fiona Bruce what makes them more qualified to sign people off.

Mr Philps said: “This is a very particular specialisation. They will be trained to identify what people can do, what they’re able to do rather than just sign them off as sick.

GPs under pressure

“GPs are under lots of pressure. We would rather they were seeing patients.

“There is also a concern that GPs being busy, being under pressure, might just be a little bit too quick to sign off a sick note.

“Having someone who is specialised in that area and who can think about what the individual is able to do, what things can they do with their condition, is a slightly more constructive way to look at it.”

Munira Wilson, the Liberal Democrats’ education spokesperson, said: “People who can’t work desperately want to work but are stuck on NHS waiting lists.”

She said the Lib Dems would introduce a ‘GP guarantee’ that you could see a GP within seven days by recruiting another 8,000 GPs.

“We also need to talk about public health,” she added. “We need to help people to stay well better.”

Sign up to be a DAUK member and support our work.

Watch the Question Time debate again.

It is putting PAs at risk of being placed in positions they have limited training for and this is less safe for patients, he said.

Dr Taylor, GP spokesperson for the Doctors’ Association UK (DAUK), was contributing to an article on why trained GPs are unable to get a job.

The reason, the article on iNews said, was because surgeries are employing pharmacists, physios and PAs.

Dr Taylor said: “People like pharmacists, physios and mental health workers have been proven to be effective in primary care.

“The role that is causing a lot of consternation is the physician associate (PA). This isn’t the fault of PAs, because I think they’ve been thrown to the wolves, but they’re effectively being used to get healthcare done cheaper.”

DAUK’s GP spokesperson Dr Steve Taylor

DAUK acknowledges that PAs have a part to play in the NHS. However, DAUK’s co-chair Ms Helen Fernandes said the Association was concerned that their roles have ‘morphed over time’ and are being ‘substituted into roles traditionally populated by a doctor’.

Dr Taylor questioned that, as well as the patient safety risk of being seen by a PA, whether the tax-payer was getting value for money.

He told iNews: “A GP has 10 years of training, whereas a PA has two. They can’t know what they don’t know, and I don’t think they’re necessarily getting the supervision a GP trainee would get.

“We’re effectively paying someone who’s a little bit cheaper, but nowhere near as qualified, [instead of] people who are more expensive but will do twice as much work and not make as many mistakes.”

He added: “There has been a good push from the government to recruit extra GP trainees. We’ve seen a lot more trainees coming through the system. That would be fine if there was funding to employ them at the other end, but the funding per patient that practices receive has fallen 20 per cent in real terms since 2016.”

Dr Taylor also contributed to an article in the Daily Mail exploring the lack of work opportunities for qualified GPs.

The article said that a GP had been working as a taxi driver in the Midlands for the past two or three months because they had struggled to secure work as a locum or salaried GP.

Dr Taylor said it was not an isolated case. 

“There are increasing reports of doctors not getting the work they want,” he said. ‘I did a little poll recently – at least 50 per cent of GPs were struggling to get the work they wanted.

“Some were locums not getting as much work as they wanted, some were partners not getting the hours they wanted, and some salaried. In summary it’s a lack of funding within core GP services.”

GPs, he said, were increasingly taking shifts in roles outside general practice including in urgent treatment centres and A&E.

“It’s ridiculous,” Dr Taylor said. “I was getting emails daily offering locum work last year – but I’ve not had a single email for four months.”

Sir, More reorganisation will not solve the crisis with NHS waiting lists or prevent chronic disease, inevitably worsening care as resources are diverted to plan the shuffle (“GPs nationalised in Javid plan to reduced hospital admissions”, Jan 29). It is well evidenced that what reduces hospital admissions is continuity of care, ie seeing the same GPs over a number of years. The issue is workforce retention. We have fewer GPs than ever before yet are offering more appointments. The job is highly stressful, often miserable.

Public health faced a similar reorganisation and has seen its budget decimated, and we wonder why we have rising numbers of chronic conditions. We suggest the health secretary visits some GP practices to understand the issues.

It is also important to note that there is no charge for sick notes, which are now called “fit notes”. The private work extends only to non-NHS work such as insurance reports, medicals and private letters. The income from this is minimal.
Dr Lizzie Toberty
GP lead, Doctors’ Association UK