Factoids are not us

News from Nowhere got into trouble in December when a reader wrote: I am very supportive of the GP cause and defend GPs at every turn, [but] my only problem is that the "90% of contacts in the NHS" stat is a "zombie factoid" that has always been a lie. It is based on the assumption that one hospital admission = one contact whereas during that admission people will be seen again and again and again by consultants (often from several disciplines), Advanced Care Practitioners, Physios, Occupational Therapists, Pharmacists etc, [and many] have investigations and reports by Radiographers/Radiologists etc. Yet a whole Finished Consultant Episode in hospital is counted the same as one 15 min GP consult or appointment with practice nurse. 

Suitably chastened, News from Nowhere points out the comparison was of footfall, not diagnosis and/or treatment. The 90% claim appeared first in an early Department of Health Communication on long term conditions that has been cited repeatedly and uncritically ever since. It is time to phase it out, perhaps.

Keeping powder dry?

Another reader challenged us about muted goings on at Labour’s National Conference. We were surprised to find a story about the ejection of a SHA activist from the Labour Conference in minutes of a meeting. Why was the organisation not more indignant? No doubt someone will tell us, in due course. 

Unemployed Locums in General Practice

A decade ago one of the big themes in the General Practitioner press was how impossible it was becoming for younger GPs to find partnerships, or even to find jobs at all. That changed quickly and the narrative shifted to practices being unable to fill vacancies. The consequences were that locums and salaried doctors could charge practices high rates and obtain generous terms for their services, like no early or late shifts, limited numbers of patients in each clinic, no home visits and no paperwork.  

The situation has changed once again. We are now hearing more and more reports of locums struggling to find work, whilst in some places even salaried jobs are not available. The public continues to complain about difficulties in getting consultations with GPs, whilst the GPs complain that they are doing more work than they did before Covid.

It seems that underfunded practices have to rely on the cheaper options paid for by the Additional Roles Reimbursement Scheme (ARRS), launched in 2019 and due for review in 2024. GP locums have been asked to consider reductions in their expected hourly rate whilst also accepting a reduction in available roles, in part due to the increase in ARRS staff. Now the professional power holders’ focus is on Physician Associates (PAs).

The problem is that PAs – just like pharmacists, paramedics or first contact physios – aren’t GPs. They are assets when given task-specific work compatible with their training and capabilities but are a potential threat to patient safety if filling in the role of GP.

However, PAs partially filling in for GPs was always the logical conclusion of the ARRS. If the NHS funds practices to employ some types of professionals, the chances are that that is what they will employ. This is especially so when practice funding is being reduced during the cost-of-living crisis. This gives the illusion that enough GP appointments are being offered when we know they are not. 

There is a really easy way out of this, of course: allow practices and primary care networks to use ARRS money to employ GP locums. This could potentially improve patient safety, which has to be the priority for the NHS and the Government. Trusting in GPs to spend this funding on the right roles is a could be a much better approach than the current ‘NHS England knows best’ attitude.

Source: Jaimie Kaffash www.pulsetoday.co.uk/views/editors-blog/has-the-recruitment-crisis-come-full-circle/    

The staffing problem (again)

It is conventional wisdom in the NHS that workforce needs have been ignored for years. Not so, at least in medicine. Manpower (now workforce) has been a topic since 1957 (The Willink Report), with further debates in 1967 (Royal Commission on doctor and dentist remuneration), 1968 (Todd report on medical education), 1978 (Royal Commission on the NHS), 1981 (Short Report) and 1992 (Standing committee on medical manpower).

It seems true to say that successive reviews of wider staffing have come to similar conclusions. The UK is reliant on international recruitment and runs numerous recruitment initiatives overseas. The NHS is less interested in retention and has almost no interest in returners. It is surprisingly short-sighted in preparing for workforce ageing or acknowledging the likelihood that people may wish to have children or need to support family members. 

Recruitment from outside the UK is a major source of supply. In 2023 more than two-fifths of the 357,198 doctors licensed to practice in UK were from abroad: 209,114 (59%) had graduated in the four UK nations, 36,058 were from 27 EU countries, and112,026 obtained their medical degree elsewhere in the world. There is no way of avoiding recruitment abroad. If the NHS recruited every school leaver for 5 years it still would not be able to fill its vacancies.

Source: https://www.rand.org/randeurope/research/projects/cambridge-centre-for-health-services-research-cchsr.html 

Does distance matter?

A recent study analysed data from the Office for National Statistics to reveal the English areas with the longest average straight-line distance to the closest GP. The top 10 include practices in the east of England as well as those in the West Country.

Does it matter? Teleconsultations will soon be normal, abolishing the geographical problem for many, and there are other ways of measuring how far away services are – for instance,  buggy- or wheelchair-pushing distance – that might help reframe the problem.