The amount of money allocated to GPs in England to care for their patients is set to fall by nearly £200 million over the next three years, equal to the current funding for 1.2 million patients, the Royal College of General Practitioners (RCGP) has warned.
The proportion of NHS funding being spent on general practice has been falling for successive years, with GP practices being starved of the resources they need to meet the growing needs of patients and safeguard the future of patient care, says the RCGP.Only 9% of the NHS budget in England was spent on general practice in 2010-11, even though GPs see over one million patients per day and 90% of all NHS activity takes place in general practice, it adds. 47% of NHS spending that year went to A&E and acute care.
"General practice is the most effective and cost-effective way of providing patient care - a whole day's care in general practice costs one-tenth of a day in hospital," said RCGP chair Dr Clare Gerada.
But, she added: "funding and resources for our services is being stretched to the limits, with family doctors facing ballooning workloads, record hours being worked in surgery and real consequences for patient care."Personalised, continuous and integrated care are the cornerstones of general practice, and GPs want to be able to do more for their patients and deliver the care they deserve. General practice is becoming increasingly challenging and complex, with an ageing population and multiple conditions, and the funding it receives to provide services must reflect this, said Dr Gerada.
GPs have also seen their consultation rates "explode" in recent years, she added. "We now routinely see up to 60 patients on a daily basis, whereas even 10 years ago this would happen only in exceptional circumstances such as a flu outbreak."
"Most GPs want to help alleviate pressure on hospitals, including on A&E, with a shift back to the community, but this must be matched with adequate resourcing and we cannot continue to juggle an ever-increasing workload with a decreasing workforce," Dr Gerada warned.
The RCGP chair also responded to Health Secretary Jeremy Hunt’s speech given last week at The King's Fund, in which he said "we have allowed ourselves to lose sight of the concept of the family doctor - the sense that GPs are there to be a champion for their patients rather than simply a gateway to 'the system'," and announced that this year will see the appointment of a new Chief Inspector of General Practice.
Difficulties for patients with accessing general practice mean that "across England, our 150 A&E departments are the busiest in their history," he said, but also noted that GPs "feel rushed off their feet with a daily list of duties that can make it extremely challenging to develop trust with patients and exercise responsibility for their care - the very reasons that motivated them to join general practice in the first place."
In 2004, the GPs' new contract made them no longer responsible for their patients all the time - only during working hours Monday to Friday - thus removing "at a stroke the need to think holistically about a patient's care," said Mr Hunt.
'The result of that historic mistake is that GP practices are now remunerated not for looking after people as individuals, but for complying with a myriad of targets and requirements," he added.
The new Chief Inspector of General Practice will work inside the Care Quality Commission (CQC) and alongside the Chief Inspectors of Hospitals and of Social Care to help drive up standards of excellence in GP practices across England "through clear, open and robust assessments of how well each practice is serving its patients," said Mr Hunt.
Dr Gerada responded that most GPs would find the Health Secretary's comments "bittersweet." While he acknowledges the value of general practice as the cornerstone of patient care across the entire NHS and the pressures which GPs are now under, he also "insults the reputation of hardworking GPs by accusing us of failing in our responsibilities to patients out of hours," she said, and urged him to work with the profession to identify real solutions, backed up by proper investment, rather than apportioning blame.
Candace Imison, acting director of policy at The King's Fund, welcomed Mr Hunt's comments on the widespread variations in quality of care provided by GPs, an issue which she said rarely gets the attention it deserves. She also welcomed the appointment of the new Chief Inspector but added: "regulation and inspection can only provide a backstop - the main responsibility for quality of care lies with GPs and their practices."
