The last 28 days have been eventful; London's GPs declaring a state of emergency; almost immediately Simon Steven's saying the cavalry is on its way ... in about two years time; and a new Mayor saying he'll be the first "to provide real leadership for London's NHS". We've also seen the first all-out junior doctor strike, the first anniversary of the Government's election victory and the King's Fund reporting that general practice is facing a crisis. That's plenty to take stock of.
That UK general practice, the envy of most of the rest of the world, is in a state of emergency cannot now be understated; increasing demand, falling funding, and staff burnout are creating untenable pressures. A recent survey conducted by Londonwide LMCs found that 31% of London practices have a GP vacancy. With clinical workload up 16 percent in the last seven years and projections that by 2020 the population of London will be 9.2 million, up 500,000 on 2014, something has to give. On top of this GPs are bullied by bean counting bureaucrats, over inspected on factors which, frankly, lend more to the electoral hopes of politicians than indicate patient safety, and scraping around to cover spiralling professional insurance costs generated by ambulance-chasers and an unaffordable seven-day consumerist approach to routine healthcare generated by those ideologists seeking to create an international market out of our NHS.
As we went to the polls on Thursday, the King's Fund, not known for its empathy with GPs, published its report Understanding pressures in general practice, arguing that the Department of Health and NHS England have consistently failed in collecting national level data which could have anticipated the crisis that has now emerged. It says that general practice is at risk of falling apart.
The stark truth is that patients are already losing their GPs and will continue to lose them unless pressures on general practice are dramatically eased. General practice is at breaking point. That's neither safe nor fair for patients or staff, right now.
GP Forward View
We know this isn't where we are supposed to be; in fact we were told we wouldn't end up here. The Five Year Forward View pledged to "stabilise core funding for general practice nationally over the next two years". In less than six months' time, on 23 October, those two years are up. But general practice funding feels far from stable and there is no sign that it's going to be brought onto an even keel in the next five months.
Last month's General Practice Forward View has been badged as a cure-all for hard-pressed GPs and practice teams. But the reality falls far short of what is needed to address the challenges facing general practice in the Capital and beyond. Sadly, the long awaited GP roadmap seems to have taken us as far as spaghetti junction – with loops of recycled policy, partial investment, and confusing signage. Meanwhile, GPs are in a state of emergency.
The new man at City Hall
The Capital is the worst area in England for childhood obesity - 10 percent of children in primary school reception classes are obese, rising to 22 percent by year six. This frequently results in diabetes, which will affect 566,000, or eight percent, of Londoners by the end of the Mayor's term in 2020.
So while the newly elected London Mayor may not hold direct responsibility for health, Sadiq Khan's actions can have a huge impact in the health of Londoners; housing, transport and planning are all factors impacting on health in the city. Good quality public house, better protection for parks and sports facilities and new developments which have outside spaces can all improve the lot of some of London's most unhealthy families. So said Lord Darzi in his Better Health For London Report.
London GPs are invested in the success of primary care in the capital and want to work with the Mayor to provide accessible, impactful primary care at the heart of local communities. While there are no simple solutions, there are some basic first steps around community care coordination, public health activity and education. Before pushing through grand plans and schemes for increased access, we must first be confident that we can maintain a safe service for patients. I look forward to talking to Sadiq about how his responsibility for housing, planning and transport can benefit patients at the point that they begin their NHS journey, in general practice.