Dear Mr Hunt,
Thank you so much for your kind speech detailing the new deal for GPs that you announced today. We have been waiting with baited breath to see what you would come up with. Well, you didn't disappoint.
You fulfilled all the expectations of vague headline filling promises - 5000 more GPs, 5000 other clinicians. I notice you sneaked Physician Assistants into that last bit with Pharmacists and Nurses, gently implying that they are a proper job with a role in the UK healthcare system. Nicely done. You kept a lid on the time-scale - clever. I'm sure we will have 5000 more GPs over the next 50 years, but it's minor detail.
You're going to market general practice to the best and brightest students. Smashing. What are you going to tell them? Is it the bit about not investing any more money in primary care? I think they'll like that. Is it the part about giving us data ("Data!!" I hear them shrieking in fevered excitement as they choose their careers), that will tell us which areas of the country are under-doctored? I'm always keen to save the Department of Health time and money - you have got to find £22 billion of efficiency savings after all. So get ready, the under-doctored areas are..... the whole country, apart from your constituency, which is why you don't seem to care about it. Job done.
So now we've attracted their attention, and I think you'll agree it's going well so far, you're going to tell them about the extra year of training they can do before they qualify are you? It's a lovely, lovely idea. Very similar to the one that the Royal College of GPs had a few years ago, but that was quietly shelved because it would slow down the number of new GPs coming through and would have made this whole recruitment crisis happen a bit earlier. Which would have looked pretty bad for the Government - which was you interestingly, wasn't it? Don't worry, rather than putting the extra year of training into general practice and killing two birds with one stone, you've put them in other areas, and delayed those doctors qualifying while in the middle of a recruitment crisis. If I was the doctor advising you - and I realise that is unlikely to happen - I'd have said:
"Jeremy, it's a delightful idea. But surgeries are closing because there aren't enough doctors. You want to add an extra year onto their training, and not even in general practice! Let's put that idea on the "long term aims to wheel out at the next election" shelf, and sort out where the hell we are going to get these 5000 extra GPs you keep promising."
You want these bright new recruits to come on a journey with you. To join a partnership in providing care. Hmmm. I like the financial incentives part - a bone of realism there, although I note the wording "explore the idea of offering financial incentives" keeps it non-committal. Bearing in mind that a scheme offering £20,000 golden hellos to new recruits in Leicestershire was ended after it failed to attract more than three doctors, you do need to listen when we say it isn't about the money.
You're doing a marketing campaign too - yippee! A few posters will do the trick. You're offering flexibility for part time GPs - I think that already exists, but nice try.
I can see a bit of investment in premises, and a programme to help struggling practices. All good, all good. A couple of top tips from the coalface though. Based on personal experience, NHS England's response to struggling practices is shocking. If you could get them to stop shrugging their shoulders and muttering about contracts, then standing by while the practice goes under, that would be amazing. Or stop them doing stupid things like making mystery shopper calls to neighbouring practices when 10,000 patients have suddenly lost their GP, wasting everyone's time instead of solving the problem, I think we would all be delighted.
There's another few mentions of giving us data - just let me contain my excitement again. Data to show that we are "providing the outcomes for the patients who rely on us most". Interesting wording. I read that as "more targets that take you away from seeing patients". You've got someone working with the CQC and NHS England on this, so it is guaranteed to go down well with jobbing doctors.
You want us to "respond to the needs of busy, working families" by offering seven day opening for routine medical care. Another big tick on reasons for those best and brightest to join us. You seem to have made all of the above, frankly underwhelming commitments, based on all practices offering seven day a week opening. A bright, magic new future for general practice.
The BBC published a poorly worded article on their news website this week, asking "Why are GPs so angry?" - there's been a lot of chat online about this, and let me share some a few replies with you, from working GPs across the country.
"The never ending increase in workload without adequate resources"
"Being told we do everything badly"
"Bureaucracy and over-regulation of everything we do"
"Feeling that despite trying my hardest and putting in far more than the public seem to think, I am letting my patients down. I just can't give anymore"
So Jeremy - we aren't a complicated bunch. All you needed to do was invest more in general practice - give primary care the 11% of the NHS budget it used to have, and we will solve the rest. Cut the bad press, because you know you can with a few phone calls to the right people. Ditch the pointless regulation and box ticking. Let us do our job. You still haven't realised how dire things are. No-one can recruit. It won't improve with this insipid panacea. Where I work, one GP training scheme has NO trainees next year. None. Another has a third of the places filled. The last one, only half.
This new deal? There's nothing in it that makes me hopeful, or makes me feel you understand what you are dealing with. NHS general practice is collapsing. To persuade any young doctors to go into it now, the carrot needs to be a whole lot bigger than the stick. So thanks, but no thanks.
On behalf of all hard-working GPs in the country,
Dr Zoe Norris.