By Mark Blackwood
The professional membership body for family doctors in Britain, The Royal College of General Practitioners (RCGP), is warning that the future of health care provided by General Practitioners (GPs) is “under severe threat of extinction”.
RCGP president Dr Maureen Baker told the Guardian that the GP healthcare service, which is the bedrock of the National Health Service (NHS) and accounts for 90 percent of all patient contact is “in crisis”. “GPs and practice nurses can’t keep doing more for less now that funding for general practice in England has slumped to just 8.5 percent of the NHS budget,” it states. Spending on the service has been cut in real terms by £9 billion since 2004/05 at the same time as patient consultations have skyrocketed. They are predicted to increase by a further 69 million by 2017.
The pressure on smaller surgeries is also set to increase now that, from this month, the Minimum Practice Income Guarantee (MPIG) is being replaced by the new General Medical Service contract (nGMS). MPIG is a regulatory safeguard introduced in 2004 as a means to ensure the survival of small practices by guaranteeing a minimum level of funding irrespective of the number of patients on their books. Some 98 GP surgeries have already been placed under risk of closure as a result of the introduction of the nGMS.
The warnings made by the RCGP have been echoed by other health professionals. Dr Chaand Nagpaul, chairman of the British Medical Association (BMA) GP committee, recently spoke on the funding crisis with medical news outlet Commissioning.Gp stating, “It is clear general practice is facing a workload disaster that is threatening its long term future.”
Dr Nagpaul went on to further explain “We are seeing morale dip to a level that I cannot remember in my 25 years as a GP”. Discussing why the situation has become so critical Dr Nagpaul identifies the root cause as being that “GP practices are facing an unprecedented combination of rising patient demand, and declining resources.”
At last year’s BMA local medical committees conference, Liverpool GP Andrew Taylor issued the warning that “general practice is dying” pleading with delegates, “Don’t let deceitful, duplicitous politicians and governments destroy the GP jewel in your NHS crown”. Newcastle GP Gerard Reissmann likewise insisted, “This isn’t our doing, we are watching this car crash and we are saying this is happening”.
The seventh National GP work life survey (2013), conducted by Manchester University, revealed that 86 percent of GP’s reported rising pressure from increasing workloads. Among the main factors GPs attributed this to was increased paperwork (81 percent) and lack of time to carry out their job (78 percent). GP job satisfaction in 2012 plummeted to its lowest point since 2001, with stress among GPs currently reaching a 15 year high.
While the RGCP report emphasised that GP funding faces a greater proportional decline relative to funding for hospitals, this should not obscure the reality that the Conservative/Liberal-Democrat coalition government is slashing the overall NHS budget. This is central to its strategy to liquidate what remains of free, public health care provision in the UK.
Almost a third of the NHS budget is set to be wiped out by 2021 through the imposition of so-called “efficiency savings”, a euphemism concealing deep structural cuts of £30 billion to services and jobs. This is alongside sweeping privatisations.
One consequence of the cut in GP funding has been increasing pressure on Accident and Emergency (A&E) departments. Longer waiting lists for GP appointments and severely curtailed patient-GP contact times have been a major factor for the increasing numbers of people being forced to go to A&E instead.
At the end of last year medical director of NHS England, Professor Sir Bruce Keogh, seized on the A&E crisis to make a cynical call on GPs to relieve the pressure on A&E departments and for more A&E work to be carried out by private providers. This underscores that it is not various parts of the NHS which are being cut to the point of extinction but the entire NHS itself.
NHS England–the body created to drive through the coalition’s assault on the NHS as set out in the Health and Social Care Act 2012–has endeavoured to defend itself from criticism by claiming, “the new approach we are taking will really make a difference and deliver the improved health outcomes we all want to see”.
Irrespective of the claims made by NHS England the facts speak for themselves.
Since 2010, some 60,000 front line nursing related posts have been cut, along with the closure of 54 NHS walk in centres. Nationally over 34 A&E units have been earmarked for closure since 2010, with 70-100 units set to be downgraded to ordinary non-specialist Emergency Centres. Of the 58 NHS Mental Health Trusts in England almost half are currently running at 100 percent occupancy for mental health beds, well above the 85 percent recommended by the Royal College of Psychiatry. The situation is made worse by the real terms cut of 2.4 percent to the mental health budget over the last two years. This has led to a reduction of 1,711 mental health beds in the NHS.
At the end of March, Britain’s leading brain doctors sent a damning letter of NHS executives protesting the planned closure of 18 brain cancer specialist units. The letter, which was leaked to the Daily Mirror, was signed by 13 leading clinicians attacking plans to reduce the number of specialist units from 25 to seven and restrict access to advanced radiotherapy treatments.
The letter was written by leading consultant neurosurgeon Matthias Radatz who described the changes made to the NHS as “draconian”. “To the layman it’s appalling. To the expert it’s appalling,” he said.
Radatz, chair of the Radiosurgery Clinical Review Group, said NHS England– was “acting out of spite or ignorance”. The letter warned strongly at the “potential risk of harming individual patients due to delayed treatment.”
No trust whatsoever can be placed in Labour to reverse the attack on the NHS. It was the previous Labour government that drew up proposals for the unprecedented £20 billion cut to the NHS budget, which is now being ruthlessly implemented by the present government. Closed door talks are taking place discussing how to increase these cuts to £30 billion by 2021.