Expert calls for 'coherent plan' to prevent disintegration of British general practice

Stethoscope

We urgently need a coherent plan for workforce development and funding to prevent the disintegration of British general practice, warns an expert in The BMJ this week.

Veronica Wilkie, Professor of Primary Care at the University of Worcester, recalls a report published in 1950 by Australian researcher JS Collings that described the standard of British general practice as appalling.

The Collings report was a wake-up call, she says, and led to several initiatives, including the Royal College of General Practitioners and the development of group practices.

Yet she points out that, this year, two workforce reviews both concluded that we have too few GPs and that those we do have are stressed, burning out, and feeling increasingly unable to deliver healthcare safely.

Funding is at an all time low, at 8.3% of the NHS budget; the number of GPs per capita is falling; and the demands on clinicians’ time are rising because GPs carry out more than 90% of all medical contacts for the NHS (from a total of 309 million consultations in general practice in 2008), she explains.

The reports also recognise that more women are now GPs and that more of the workforce is working part time - and they identify the rising primary care workload associated with an increasingly frail population.

Both reports look to strategies to increase the numbers of GPs in training, through undergraduate experience and more flexible training, writes Wilkie. “But what neither report recognises is that students and trainees who witness stressed, burnt out GPs, who feel isolated and unsupported, are unlikely to choose general practice, regardless of the marketing,” she argues. “And preventing attrition in the existing workforce is as important as recruiting new trainees,” she adds.

“We need a coherent plan for workforce development in primary care, taking into account undergraduate and postgraduate training and beyond, with a robust funding plan that is flexible enough to reflect the local population’s needs but big enough to prevent further disintegration and a lack of investment,” she writes.

She points out that the NHS was recently recognised as being the best performing health system of 11 countries studied. “We need to sustain our standing by considering healthcare provision in the long term - evolving an integrated primary care system rather than destroying it,” she argues.

“We should learn from the past and protect the future,” she concludes. “The health service has always been more than the sum of its parts. How many more reports need to be published before action is taken? Is this another Collings moment?”