Dr Taylor, GP spokesperson for the Doctors’ Association UK (DAUK), was speaking on LBC radio following the release of a new internal report into NHS productivity.

The review revealed that despite a £20bn increase in funding for the service since 2018 and 15 per cent more doctors and nurses, hospitals were 11 per cent less productive than before the pandemic.

Speaking on the Tom Swarbrick programme, Dr Taylor said the money could have been spent better to provide improved outcomes.

“I think it’s the money in the wrong places,” he said. “For example, we’ve seen a 41 per cent decline in district nurses, and a decline in GPs by seven per cent, so we’re struggling to get people out of hospital.

Community care

“We’ve also seen a decline in community beds, so nursing home and residential care beds have gone down.

“There aren’t enough beds in hospital and then aren’t enough beds in the community to free up hospital beds.

“Where does the blame lie?

“It’s a good question and I think ultimately the people at the top of NHS England need to be held to account because I think some of the money is going to the wrong places.”

He added: “NHS England has been pretty much secondary care focused, which means it’s not focused its energy in unplugging the gaps in the community to allow people to get out of hospital.”

Dr Taylor said part of the problem was also a lack of investment in infrastructure.

“An analogy I’d use is if I have a kitchen providing meals for a restaurant and I decide I’ve got a bigger restaurant I need to cook more meals,” he said. “If I put more chefs in but don’t add more hobs and ovens then I’m not going to produce any more food.

“And that’s what’s going on in hospitals. We’ve put in lots more doctors and nurses in hospitals but we’ve not put in enough beds, theatre spaces, those sorts of things.”

Underinvestment in the NHS

Dr Taylor said a decade of underinvestment in the NHS had also had a huge impact. He added that the only area of the NHS that was more productive post-pandemic was general practice, despite seeing its funding slashed in real terms.

Dr Taylor, a GP of 30 years based in Manchester, said general practice could be doing even more with increased and targeted primary care funding.

“Where the money is going is not necessarily the right areas,” he said.

“For instance, they put virtual beds in the community, which are really expensive. They cost about £600 to put someone in a virtual bed, which is actually in their own home with all the tech around them.

“At the same time, they’ve cut all the community nurses.

“If we had money put where it was needed, which is in the community sector, employing more district nurses, putting money into general practice, you’re going to get support in the community which unblocks the hospitals and allows them to function.”

MPs briefing

Dr Taylor is one of four members of DAUK’s GP committee who will be sharing their thoughts on the crisis facing general practice at an online briefing for MPs on Wednesday 19 June.

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 we sent to all 650 MPs in March.

Find out more about the briefing.

Become a DAUK member and support our work.

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 Steve Taylor, DAUK spokesperson, said GPs were carrying out more face-to-face appointments than before the pandemic PLUS an additional 20 to 25 per cent online, over the phone or by video.

And that was despite there being a UK-wide shortfall of between 7,000 and 8,00 GPs, he told listeners to the Nick Ferrari programme on LBC.

He said cuts to funding were creating ‘a perfect storm’ by making it harder to recruit and retain GPs, which increases the pressure on those already in practice 

Dr Taylor said: “Funding of primary care and community care – and I don’t mean just GPs but also district nurses, health visitors and all of those things – primary care is generally underfunded, which means we don’t have enough cash in the primary care set up to recruit and retain doctors.

“There are 2,000 fewer GPs now than there were in 2015, which is a huge drop given that in 2015 we knew then that we needed 5,000 more GPs.

“That’s 7,000 or 8,000 fewer than we need now.

“I’ve been a GP for 30 years and it was better 10 years ago when overall numbers of GPs were increasing.

“But if you keep cutting community care the job gets harder and harder and there’s a perfect storm then.”

Dr Taylor added: “Overall physical access to GPs has gone up considerably over the past 12 months.

“There were more people seen face to face last year than the year before, and that’s more than in 2019.

“In addition to that, there were 20 to 25 per cent more appointments given online, by telephone and via computer access. They are the extra appointments on top.

“I know it’s surprising, there will be 1.4m people having access to GP appointments today, and 70 per cent of those will be face to face.”

The interview also touched on some of the issues facing accident and emergency departments.

According to an analysis by the Liberal Democrats, a record 420,000 patients waited more than 12 hours to be admitted to hospital from A&E in 2023 – an average of 1,150 a day – up 20 per cent on the previous year.

Dr Taylor said: “It’s dreadful. I’ve been a patient and I’ve sat with friends in A&E and it’s an awful situation.

“The overall numbers of people attending A&E aren’t hugely up, so the problem is somewhere else, so it does appear to be that the A&E departments aren’t able to move people on.

“Last year, Rishi Sunak said he would try to get 5,000 more beds for this coming winter to cover the problems and, sadly, we’re into winter and have 1,000 fewer beds than we had last winter, which is appalling.”

The interview is available below to listen to again.

Dear Editor

We are doctors’ associations representing the NHS staff and employers. We welcome the concerns raised by the BMA and other organisations. We also wish to emphasise that any form of verbal or physical abuse of health and care staff is completely unacceptable. These distressing incidents cannot and should not be tolerated.

We condemn the recent abuse and threatening behaviour towards GPs and other Primary Care staff over the last few months. Unfortunately, this phenomenon of abuse, harassment and physical abuse is deplorable. We are all aware that these are difficult times and quite often frustrating for patients, however each of us are trying their level best to deal with the problems of appointments, long waits and related issues.

The NHS already makes best use of its resources and the pandemic has put severe and an exceptional strain on these resources. Abusing GPs and their staff would worsen this situation and in no way improve the delivery of services.

We need to accept that we are all together in dealing with this challenge. We urge the government to spread confidence in the public with firm but honest statements and full support to our GPs and their healthcare staff. We ask the media to remain responsible and help in these endeavours. Our GPs and their staff should feel confident that their place of work is a place of safety.

We are pleased with the government and the NHSE statement of a support package to tackle “workload and abuse” with more Covid funding. We await the details of the proposals and initiatives with this package. We have written to the Secretary Health, Rt Hon Sajid Javid, and urged him to issue a statement to our respected public to honour their GPs and the Healthcare staff.

Mr A Sinha
Media and Communication Lead, British International Doctors Association

Mr Ghulam Abbas
President, Association of Pakistani Association of Physicians and Surgeons of UK

Mr Shabi Ahmad
General Secratary, Association of Pakistani Physicians of Northern Europe

Dr Ramesh Mehta
President, British Association of Physicians of Indian Origin

Dr Ellen Welch
Editorial Lead and GP Doctors’ Association (UK)

Mr Ibrahim Bolaji
President. Medical Association of Nigerians Across Britain

Dr Arun Baksi
Director, Our NHS Our Concern

Competing interests: No competing interests

Gp Online and Medscape wrote about our letter to Sajid Javid – you can read the letter here:

Dear The Rt Hon Sajid Javid,

We write to you as a very concerned group of GPs regarding the lack of access to secondary care referral pathways.

You will of course be aware that access to secondary care outpatient services now has extremely long waits across a range of specialities. 

This is putting huge undue pressure on primary care. For example, those waiting for joint replacements do not contact their surgeon for fit notes, pain relief, antidepressants whilst they are waiting. This is one small example of the very real-world consequences for GPs when our patients cannot gain the specialist in put they need. We are additionally seeing patients waiting months for physiotherapy and years for certain mental health assessments for autism and ADHD. These are just a few examples. 

As GPs we are seeing an increasing amount of referrals rejected at the outset. This is a huge concern for us regarding patient safety. It also often leaves nowhere to go with that patient and their care. 

Therefore, those who have the resources are turning to private referrals, those who can’t are left to suffer.

We are also concerned regarding the growth of mandated advice and guidance (A&G) as is being trialled in London currently. A&G is a brilliant tool if there is a query over patient care, or some concern over whether a referral is appropriate. 

However, as GPs, if we have decided a referral is necessary, and the situation is outside our competency then we must refer onwards, in line with GMC advice. 

Allowing specialists who have not assessed the patient themselves to make the decision whether a referral is justified, is not in keeping with the current emphasis on face-to-face consultations, and risks patient safety. 

We are witnessing a huge increase in demand in demand for private referrals. A recent poll of our members showed 100% of the doctors who replied believed private referrals were on the rise. 

Whilst private referrals have their place for some patients, patients should not need to resort to them for necessary care.

Most concerning of all, 90% of respondents believed a patient of theirs had come to harm because of a lack of access to outpatient services. 

Our worry is this lack of access to secondary care, followed by increased rationing of specialist opinions is now leading to two-tier healthcare – where the NHS is available for acute emergencies and cancer care, but to have good, appropriate management of many common conditions, patients must either fund their own care privately or suffer. This is not only against the founding principles of the NHS, it stands to widen health inequalities. 

There must be urgent action to remedy this. 

We ask:

• recognise the impact of these waits on primary care, the need for greater resources and a review into primary care access
• recognise that if GPs need to refer patients, rejection of referrals must be the exception. A clear explanation and alternative plan must be given. All rejection letters should be personalised and written directly to the patient, with the GP copied in
• halt all moves to mandate A&G
• continue discussions to reduce waiting times
• finally, please visit our practices. Please come and understand first-hand the pressures we are under and listen to the solutions. Some things need decades to remedy, but there are quick wins too.

We look forward to hearing from you.

DAUK GP committee

Doctors for the NHS

GP Survival

999 Call for the NHS

“The lack of GP access to secondary care referral pathways is not acceptable”, say doctors from The Doctors’ Association, Doctors for the NHS, GP Survival and 999 Call for the NHS in an open letter to Health Secretary Sajid Javid.

With an ever-increasing strain on primary care, GPs are currently under huge pressure to care for patients who may be waiting for hospital care, such as someone waiting for a joint replacement, and needs medication for pain, or antidepressants when the wait gets too much. In addition, GPs are also picking up the fall out for patients who are having to wait months for physiotherapy and years for assessments for autism and ADHD.

And it is no coincidence that GPs are seeing a huge increase in demand for private referrals; 100% of DAUK members who completed a recent poll believed that requests for private referrals are rising. This is in part due to a large number of referrals being rejected, which leaves patients who can afford to, to pay for private care, and those who can’t, to suffer.

Dr Lizzie Toberty, GP Lead for DAUK, believes even advice and guidance (A&G) is becoming another hurdle to climb, as it appears to be so heavily mandated that GPs are being prevented from referring onwards when required.

She says, “If a GP has decided a referral is necessary, and the situation is outside their competency then they must refer onwards, in line with GMC advice. 

Allowing specialists who have not assessed the patient themselves to make the decision whether a referral is justified, is not in keeping with the current emphasis on face-to-face consultations, and risks patient safety.”

The NHS is becoming a two-tier system with lack of referrals and long waiting lists forcing an inequality of medical care within the population. DAUK, Doctors for the NHS, GP Survival and 999 Call for the NHS are calling for the Rt Hon Sajid Javid to urgently review and act on the following points:

• To recognise the impact of these waits on primary care, the need for greater resources and a review into primary care access
• To recognise that when GPs decide to refer patients to other services, rejection of referrals must be the exception. A clear explanation and alternative plan must be given. All rejection letters should be personalised and written directly to the patient, with the GP copied in.
• To halt all moves to mandate A&G
• To continue discussions to reduce waiting times
• And finally, to visit our practices. Please come and understand first-hand the pressures we are under and listen to the solutions. Some things need decades to remedy, but there are quick wins too.

Speaking for Doctors for the NHS, spokesperson Alan Taman said:

“The growing trend in private referrals demonstrates the critical need to invest in the NHS and redress problems over staffing which have been building for years, and will take years to resolve. People should not have to face paying for their own treatment because they will otherwise have to endure waits of months to years – or can no longer get treatment from the NHS because it has been cut. Privatisation is not as a rule happening on a large contractual basis, through competition by private companies for service contracts, at least not yet. It’s happening one worried person at a time, those who can afford to pay or increasingly who can put themselves into debt.”

Steve Carne, Chair of 999 Call for the NHS said: “GPs play such an important role in our healthcare service and the Government should be supporting and celebrating their contribution to the nation’s health. GPs are being subjected to relentless demands with less and less resources. We fully support the call for the Health Secretary to listen and understand the full picture of dangers faced by GPs and the NHS workforce”

ENDS

For further information:

Doctors’ Association UK – DAUK is a professional association for UK doctors. Run by frontline NHS doctors, DAUK campaigns for patients and the NHS as well as advocating for the medical profession press@dauk.org

Doctors for the NHS –  Doctors for the NHS (DFNHS) was formed in March 2015 by the NHS Consultants’ Association (NHSCA) re-naming itself and asking GPs and medical trainees to join. NHSCA was formed in 1976 and was the oldest continual health-campaigning group with DFNHS’s aims. DFNHS has just over 600 members nationwide, most of whom are senior Consultants or retired senior Consultants. Its membership represents many years of experience in the NHS, often at the highest clinical levels. It has the explicit aim of countering marketisation of the NHS by gathering the already impressive evidence; pointing to the ill effects of commercialisation and systematic under-funding on NHS services and founding principles; and campaigning widely to stop then repair the damage before it is too late and cannot be reversed. 

DFNHS’s press contact is Alan Taman:

07870 757 309

healthjournos@gmail.com

GP Survival – A grassroots movement of GPs fighting for the survival of General practice in the U https://www.generalpracticesurvival.com

999 Call for the NHS – 999 Call for the NHS is a national campaign group that supports a network of local campaign groups who are passionate about returning healthcare in England to a fully restored public service with no internal commercial market.

 In our 7yr history we have marched from Jarrow to London and fought a 2 year legal battle with NHS England over the introduction of a USA style ‘Integrated Care Provider’ contract. We are currently working with a network of campaigns to scrap the Health&Care Bill which, if passed, will see and end to the ethos of a  National Healthcare Service that is available to everyone regardless of ability to pay. 

“Let them eat cake”, said Marie Antoinette prior to the French Revolution – revealing how out of touch the Queen was from her people. Once widely reported, it contributed to the uprising and her eventual demise. However, she never said it. It is one of history’s earliest examples of propaganda. A statement so powerful that many of us still believe now. 

“Your GP surgery is closed” has become the propaganda of the pandemic. According to many journalists, GPs are work-shy, greedy capitalists, who should be paid less so they can’t work part-time. 

These persistent distortions have filtered down to our patients. Most GPs have been asked, “when are you re-opening?” by patients actively being examined, in an open GP surgery. 

More worrying are those that have stayed away. Women with long-standing breast lumps who didn’t seek timely help because “you were closed”. Coughing children with chronic lung conditions, whose parents thought they couldn’t be seen until their child’s Covid test was back, and the lady with a heart attack, who sat at home for three weeks with chest pain but “didn’t want to bother anyone”. The consequences of this false narrative are deadly serious.

Undoubtedly, there are problems accessing care – but not for the reasons plastered across the tabloids. We have an acute shortage of GPs, fewer than in 2015 and less than a sixth – per head of the population than in compatible European nations. UK GPs are routinely working 10 to 12 hour days. 

Fast, good and cheap. You can have only two when it comes to primary care.

Pre-pandemic we were managing cheap. 90 per cent of interactions provided for 8 per cent of the budget. Good? It seemed so, but we were certainly not fast, with on average, a two week wait to see a GP.

When covid hit and we switched to remote consulting, we found something remarkable. We could work efficiently and discovered many primary care issues could be handled remotely, providing a convenient service for our working age patients in particular. For those with complex needs, or those whom an examination was vital, we worked hard to provide face-to-face appointments.

Despite our efforts, there has been a strong press narrative that our practices have been closed to patients and that GPs have been hiding away. Primary care delivered 75 per cent of Covid vaccines and performs over 30 million appointments each month – but we’ve been branded lazy.

GPs are paid on a contract per patient, per year, at around £130 which remains the same if you never visit your GP or if you go every week. This is similar to the cost of one private GP appointment and half the cost of one hospital out-patient appointment.

When demand goes up – like now – there’s no more money to fund this. The only way is to work harder. And work as we might, it is still not enough. 

GPs are burning out. Dealing with the fallout from the pandemic, 12 hour days and rising levels of abuse is exhausting. 

The Practitioner Health Programme, a service providing mental health support to doctors, reports more GPs referred themselves in the last year as in the total nine years previously. Rates of sickness, retirement and resignation are colossal. 

Berating GPs about problems accessing care is in the interests of those who would benefit from private takeover – which would not benefit patients or GPs in the long-term.

Without adequate resources, frontline GPs can do very little to remedy these problems. We need a proper investigation into the problem, as suggested by Healthwatch, alongside serious conversations about funding and what we are willing to pay. We need more funding and better working conditions to promote staff retention. Fast, good and cheap. Which two would you like? 

If we don’t address these problems, the line “GP was closed and never re-opened after the pandemic” may be the propaganda my great-great grandchildren will be reading about in history.

Dr Lizzie Toberty and Dr Ellen Welch are GPs and members of the Doctors’ Association U.K.