As we study a new Queen's Speech, it seems a good time to reflect on what has been a busy twelve months for general practice:
- In May 2015 we saw the end of the political coalition created in 2010, the departure of Liberal Democrat Ministers across Government and some new faces and more bullish attitudes at the Department of Health.
- As the Conservative leader returned to Downing Street with a slim majority and a manifesto commitment to "...increase spending on the NHS, provide 7-day a week access to your GP and deliver a truly 7-day NHS", the subsequent Queen's Speech saw a renewed commitment to the Five Year Forward View and it's aspiration on sustainable funding for general practice by October 2016.
- June saw the unveiling of the 'New Deal' for GPs, promising next day appointments, named GPs and seven day access to primary care services. All delivered via an additional 5,000 GPs.
- Six months ago the November 2015 Spending Review told local authorities that whilst there were swingeing cuts being made to community and public health finance this £200m cut could be recouped by raising local taxation directly from council tax payers.
- And most recently, in April 2016, we had the announcement of the brand new General Practice Forward View. Which promises increased staff, tech and support for GPs and their teams. Much from rebadged recycled finance.
Well... it would be if it were all happening with new, unallocated resources to help overwhelmed staff cope with the existing pressures and bring in extra resources to manage the change, and to deliver the extended hours and commitments. But that isn't the case.
The Five Year Forward View's commitment to stable funding for general practice by October 2016 is ringing increasingly hollow and with clinician numbers down and nearly half of all of the GP practices in the Capital reporting at least one GP or nurse vacancy, Government commitments to guaranteed next day appointments and seven day working appear unworkable. And increasingly unbelievable.
Ministers would say that the promised extra 5,000 GPs over five years will help. Well, they might if they were real, but that figure is beginning to unravel. In November Health Education England told the Health Select Committee that the number of "new" general practice doctors would be closer to 3,500 and includes not only new starters, but retained staff (who have been talked out of retirement, but are on the books at the moment). And that they are not all GPs but many are trainee doctors or registrars who need help and supervision as they learn the ropes.
Alongside short staffed teams stretched over longer opening hours with inexperienced, still training staff, we have the impact of local authority cuts to community and public health finance which will, inevitably, increase demand on general practice and the repackaging of previously offered funds for tech and support solutions that will, inevitably, take increasingly valuable time away from the fro nt line.
Meanwhile, the fallout from the dispute between the Secretary of State and junior doctors doesn't bode well for London practices reliant on incoming GP trainees. With fewer trainees, reducing numbers choosing general practice as a specialism and London a new exporter of trainees (whether due to workload or living costs), there is a perfect storm gathering. And there's not enough cover!