Doctors Association UK (DAUK) GP co-leads Dr Sarah Jacques and Dr Steve Taylor highlight the cases of nine-year-old Dylan Cope and eight-year-old Ethan Hanson.

In both cases, the children were appropriately assessed in primary care and urgently referred to hospital by their GP.

However, according to the coroners’ findings, neither child was assessed by a doctor after arriving at hospital.

Patient safety

Dr Jacques and Dr Taylor’s letter states: “These cases raise serious questions about the safety of current assessment systems in emergency departments and the roles of non-doctors.

“When a GP refers a patient to hospital, that referral represents a clinical judgment that is the equivalent of a medical consultant opinion in the community, and thus necessitates a further medical assessment.”

DAUK is urging health secretary James Murray to introduce clear national standards to ensure patients referred by GPs are assessed by a doctor on arrival in hospital.

They are:

• Any patient referred by a community GP to hospital by a GP must be assessed by a doctor in the hospital.
• No patient presenting with undifferentiated (undiagnosed) symptoms should be allowed to be assessed or discharged without the approval of a doctor.
• We ask the Secretary of State to review the current status of assessments in emergency departments to ensure patient safety is the priority and that doctors are involved in all cases of undifferentiated care and GP referrals.

Improvements in clinical practice

In their letter, Dr Jacques and Dr Taylor said: “It’s vital we ensure that the issues identified by the coroners in the cases of Dylan Cope and Ethan Hanson lead to improvements in clinical practice.”

DAUK has invited Mr Murray and Department of Health officials to discuss the proposals.

Read the letter in full.

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The committee says the report has ‘accurately identified many of the major issues facing general practice’, but said it was now keen to hear from the Government what the solutions would be.

Lord Darzi was commissioned by the new Government in July to conduct an immediate and independent investigation into the NHS, which DAUK gave evidence to.

In his report, Lord Darzi said ‘spending in primary and community settings had a superior return on investment when compared with acute hospital services’.

He said ‘therefore it makes sense that this should be the fundamental strategic shift that the NHS aspires to make’.

But he said that GPs do not have the resources or infrastructure to manage and coordinate the ‘increasingly complex care’ that was expected of them.

Major issues

Dr Lizzie Toberty, DAUK’s GP lead, said: “Lord Darzi accurately identifies many of the major issues including poor buildings, lack of IT and an over focus on hospital, rather than community care.

“As GPs we are heartened he recognises how under-resourced we have been and the inequity between primary and secondary care resourcing.

“Lord Darzi rightly points out GPs have been the most financially disciplined part of the NHS.

“General practice, more specifically, the partnership model has proven how efficient, innovative and agile it can be again and again.

Dr Toberty called for clarity from the Government as to how it intends to solve the problems.

General practice

DAUK’s GP committee issued a 10-point plan before the general election to relieve the pressure on general practice, which included a call for a cross-party group to make longer term decisions for the health service.

Dr Toberty said: “Lord Darzi has identified the problems in general practice quite accurately, but his report is missing solutions.

“The Prime Minister is advocating for reform but we are not clear as to what that means or what the reform will be but we would urge the new Government to take this opportunity to look at introducing cross-party collaboration.”

Dr Toberty said another solution was to fund general practice ‘without restriction on who GPs can employ’.

She said: “Lord Darzi notes that GPs are best placed to know the community they serve and what their patients need.

“The funding needs to go directly to practices for them to use for their patients, without restrictions on who can be employed. The report rightly states that additional roles, such as physios and pharmacists, should supplement GPs, not replace them.”

Patient trust

Dr Toberty added: “When it comes to general practice, the government must realise bigger is not better.

“There is huge efficiency to be gained when GPs have the ability and time to build up trust and continuity with their patients.

“The evidence shows this provides better outcomes, lower admissions and higher patient satisfaction.

“If the benefits of continuity of care were a drug we would put it in the water.

“But these problems are not insurmountable.

“We estimate a starting point is £2 billion to restore to 2015 levels of funding. This is a relatively modest investment of £35 per patient per year – or the cost of a cup of coffee a month.

“This is the time for the revival and rebirth of general practice. Give partners some resource, protect the model and there is still time to save the NHS.”

Our vice-chair Dr Ellen Welch, a GP in the north west of England, has written about the issues facing general practice in her book Why Can’t I See My GP?, a copy of which was sent to every MP before the general election to put NHS at the top of the agenda.

Read Lord Darzi’s report in full.

Support the work of DAUK, sign up as a member.

The Doctor’s Association UK have written to Prof Lord Darzi of Denham, ahead of his planned review of the NHS, to highlight the key issue within General Practice. Read our letter in full below and add your support by clicking the links.

Dear Lord Darzi

We understand that you have been appointed to lead an investigation into the performance of the NHS.

As an independent group of grassroots GPs, we would like to bring a number of facts about the GP crisis to your attention:

1. There are 1,790 fewer full-time equivalent GPs working in the NHS since September 2015. (https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services)

2. A single full-time GP is now responsible for an average of 2,292 patients. This is 354 more than in September 2015. (https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services)

3. Despite this, GP practices are offering record numbers of appointments for their patients. (https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice)

4. More than 90 percent of a patient’s direct experience of the NHS is through primary care and their GP practices (https://www.gov.uk/government/news/gp-practice-data-available-for-first-time)

5. Despite growing demands for GP appointments, 6 out of 10 job-seeking GPs have struggled to find a vacancy to apply for over the past year (https://www.rcgp.org.uk/news/member-research-jobsearch-struggle)

6.  A recent BMA survey showed that 84 percent of locum GPs in England cannot find work, and 33 percent of GPs have already made definite plans to change work or career paths. This makes no sense when we have patients desperate for appointments but no money for practices to pay for these doctors (https://www.bma.org.uk/bma-media-centre/over-80-of-locum-gps-struggle-to-find-work-finds-bma-survey)

7. 64 percent of GP practices report concerns over short and long-term viability. 57 percent have experienced cashflow issues in the last 12 months. And 54 percent report that these cashflow challenges adversely affect their day to day performance (https://www.bma.org.uk/bma-media-centre/gp-patients-likely-to-suffer-unless-government-improves-inadequate-gp-contract-offer-warns-bma)

8. Over 1,000 GP practices have closed since 2015. This amounts to an average of one practice closure every three days. (https://www.bma.org.uk/bma-media-centre/gp-patients-likely-to-suffer-unless-government-improves-inadequate-gp-contract-offer-warns-bma)

9. GP core funding is just £107.57 per patient per year. https://threadreaderapp.com/thread/1812879378612908310.html

10. Schemes aimed at reducing GP appointments such as Pharmacy first, the Additional Roles and Reimbursements Scheme actually cost more money to run https://www.pulsetoday.co.uk/news/practice-personal-finance/redirect-arrs-and-pharmacy-first-funding-to-core-gp-says-dauk-manifesto/

11. US Data shows that care provided by non-physicians providers is ultimately more expensive and leads to higher rates of emergency department use https://www.ama-assn.org/practice-management/scope-practice/amid-doctor-shortage-nps-and-pas-seemed-fix-data-s-nope

12. Independent research from Carnall Farrar shows that for every £1 invested in community or primary care, there is up to a £14 return back into the local economy. (https://www.nhsconfed.org/news/extra-investment-out-hospital-care-can-reap-billions-wider-economy)

All these factors have impacted the workforce morale and greatly compromised the standard and continuity of care. Supporting general practice now, will in turn reduce the burden and cost on secondary care in the long run, as well as being an essential part of helping people feel well again.

However we really cannot continue to run on fumes. We need a commitment from NHSE and the government to significantly uplift core funding and continue to do so in line with inflation.

We, the undersigned, ask that you take these facts into consideration whilst conducting your investigation.

Yours sincerely,

Dr Shan Hussain
Dr Ellen Welch
Dr Lizzie Toberty
Dr Sarah Jacques
Dr Steve Taylor
Dr Rosie Shire

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.

Dr Taylor, a GP of more than 30 years and GP spokesperson for the Doctors’ Association UK, called on MPs to make the funding of general practice a priority when Parliament returns after the election on 4 July.

Speaking to GP Online, Dr Taylor said: “Although the election will offer the opportunity to highlight the ongoing issues in the NHS and general practice in particular, it will also delay any decisions on funding and the urgent issues facing patient care.

“With GPs facing significant issues on funding that need urgent attention, DAUK hopes that MPs will not delay decisions on funding and make it a priority on the resumption of parliament.”

MP briefing

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

The briefing was organised before the election was called and Dr Taylor urged those standing for election to attend.

He said: “It is vital all prospective MPs understand the issues facing GPs and the provision of patient care in the community.”

Dr Taylor will be joined at the briefing by colleagues from DAUK’s GP committee, including its chair Dr Lizzie Toberty, and members Dr Ellen Welch and Dr Sarah Jacques.

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.

Pharmacy First

Meanwhile, Dr Taylor has also spoken about the impact of Pharmacy First, which was launched earlier this year with the aim of easing the pressure on GPs.

Through the new service, pharmacists will be able to provide advice to patients and issue medicines for seven common conditions in sinusitis; sore throat; earache; infected insect bite; impetigo; shingles and uncomplicated urinary tract infections in women.

Dr Taylor, contributing to a Medscape feature exploring the impact of Pharmacy First, said the scheme has had ‘little positive impact on GP workload, likely neutral at best’.

He added that it was ‘ill thought, particularly at a time GP funding has been cut by 20 per cent per patient over eight years, and potentially a case of taking funds from one area to pay another to do their job less well’.

Become a DAUK member and support our campaigning and advocacy work.

In the video, Dr Welch, of our GP team, highlights the funding crisis facing general practice, and says that people are in pain and need to make tough decisions about their health.

Dr Welch, a former co-chair of the Doctors’ Association UK (DAUK), says the NHS needs investment to meet people’s needs.

She said: “We need politicians face facts and invest in the service.”

The video has been recorded for our campaign with We Own It, an independent organisation which campaigns for public ownership and against privatisation of key public services.

With 2024 set to be a general election year and the NHS a priority for the public, the campaign aims to put pressure on politicians to pledge more investment through the voices and experiences of frontline doctors and GPs.

We are asking DAUK members to highlight the need for proper NHS funding by sharing an anonymised story from when underfunding had a tangible, negative impact on an NHS patient.

Key pointers for your video:

• Tell a short story from your work that illustrates how the NHS has been degraded, specifically the negative impact you have seen on a patient.
• You don’t need to say any names of places, people or any specifically identifiable features of where you work.
• Feel free to make your video in your workwear.
• Ask politicians to ‘face the facts’ that the NHS needs massive funding. Demand they commit to investing ‘£40 billion per year to catch up with the rest of Europe’.
• Ask people to take action by clicking ‘the link above’ to send We Own It’s letter to their local general election candidates. The link will be shared alongside your video for people to take action.
• Film your video as a portrait selfie. Pop a phone in front of you, facing the main source of light, and tell your story.
• Your video should be no more than 90 seconds. You do not need to try to do it all in one take as We Own It are happy to edit out mistakes and spaces.
• Send your video to johnbosco@weownit.org.uk and We Own It will caption the video and share it on social media. If you have one, send them your handle on X, formerly known as Twitter, so they can tag you in.

Dr Welch 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.

We invite all MPs and MP candidates to join the Doctors’ Association UK (DAUK) on Wednesday 19 June (10am to 11am) for an online briefing:

Why Can’t I See My GP? The Great British Paradox

Listen to four NHS GPs share their thoughts on the problems, the solutions, and just why general practice is worth saving.

Based on the book Why Can’t I See My GP?, a copy of which we sent to all 650 MPs in March, we ask our leaders to join us ahead of the general election to ensure GP teams are at the heart of their manifestos.

We need YOUR help.

An MP is much more likely to attend if a constituent asks them to, so we’re asking you to take two minutes to click the buttons below to tweet and email your MP to ask them to attend. Thank you!

Steve Taylor, DAUK GP committee spokesperson, said the committee had significant concerns over the reported comments about Diane Abbott MP, Britain’s longest-serving black MP, which have been widely condemned as racist and misogynist.

Dr Taylor said: “Doctors’ Association UK GP committee has significant concerns over the recent comments reportedly made by Frank Hester, owner of TPP, one of the major suppliers of GP IT systems.

“The GP workforce is a diverse community of people and these alleged comments are deeply upsetting.

“It is the responsibility of all those working in and alongside the NHS, in whatever capacity, to treat all patients equally, irrespective of their race, colour, or gender.

“It’s saddening to think that one of the NHS’s contractors could allegedly express such views.

“We agree with other GP bodies that it calls into question the leadership of TPP.”

Mr Hester is founder and chief executive of TPP, which has received hundreds of millions of pounds in contracts from the NHS.

Contracts include running patient consultation computer systems used by more than 2,500 GP practices.

He has donated more than £10m to the Conservatives, which Prime Minister Rishi Sunak is under pressure to pay back following Mr Hester’s comments.

He has apologised on the social media platform X, formerly Twitter, for making ‘rude’ comments about Ms Abbott but said it ‘had nothing to do with her gender nor colour of skin’.

Ms Abbott has described the reported comments as ‘worrying’. 

Dr Lizzie Toberty, DAUK’s GP Lead, said a 1.9 per cent rise would be “completely derisory” and was well below the level of inflation.

She was responding to a report in PulseToday.co.uk that the Government’s initial offer for this year’s GP contract includes only a 1.9 per cent rise in baseline funding, at a time when other parts of the health service have received funding uplifts of six per cent.

Dr Toberty said: “A 1.9 per cent uplift is completely derisory and is yet another reduction in payments in real terms.

“We can’t possibly continue to run general practice on contract uplifts that are hugely below inflation. Our costs are astronomical and have been going up and up while we’ve had to endure cuts and freezes to our funding.

“It is clear this Government has absolutely no commitment to primary care.

“It’s becoming an increasing struggle for people to access the basics of general practice care.

“We now find out that Additional Roles Reimbursement Scheme (ARRS) staff have not reduced workloads due to a lack of skills.

“And we’re also seeing a huge amount of money being diverted to the Pharmacy First scheme.

“None of this would have been needed if the money for primary care had been spent on doctors and  nurses in the first place.

“We urge them to fund general practice appropriately. An extra £30 to £50 per patient per year would be transformational and mean we can do our job of supporting the nation’s health properly. 

“£200 per PT per year, would still represent phenomenal value.

“There is a very real possibility that if the government does not increase funding we are heading towards a dentistry model of private care being all that is available in many areas. This would be an unmitigated disaster.”

DAUK spokesperson and GP Dr Steve Taylor said: “The 1.9 per cent represents a real terms cut for GP practices who have seen a 20 per cent real terms cut in income since 2016.

“Many practices are unable to pay for core staff including GPs and some are making GPs redundant.

“This is at a time when the country needs GPs.

“The Conservative manifesto in 2015 promised 5,000 more GPs and the 2019 one promised 6,000 more. We now have 2,000 fewer GPs than 2015.

“This contract offer shows what the Government really thinks of GPs and patient care.

“Many GPs, including myself, are extremely angry, but sadly others are just leaving.”

Pulse reported that Katie Bramall-Stainer, chair of the General Practitioners Committee (GPC), has written to primary care minister Andrea Leadsom to ask her to intervene in the negotiation.

In her letter, she said: “It is with genuine regret that I write to you today to seek to markedly improve the current grossly inadequate GMS (general medical services) baseline funding increase offer of 1.9% (£178m).

“By choosing to set aside the compelling body of evidence that GPCE has presented, the starvation of core funding at a practice-level will have devastating consequences on local patient services.”