Fit for the Future: a new plan for GPs and their patients

The pressures on general practice have intensified, exacerbated by the effects of COVID-19. Without urgent action from politicians and NHS decision makers, the ability of general practice to meet patients’ needs is in jeopardy.

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General practice is the cornerstone of the NHS, helping around 50 million people in England every year, carrying out 370 million consultations last year. So, when GPs and their patients tell us that general practice is in crisis, we should all be concerned.

In 2019 the RCGP launched Fit for the Future, our vision for what we want general practice to look like in 2030. It set out how, with the right tools and support, we can revitalise and reform general practice so that it can continue to deliver world class patient care.

Three years on, the pressures on general practice have intensified even further, exacerbated by the effects of COVID-19. Without urgent action from politicians and NHS decision makers, the ability of general practice to meet patients’ needs is in jeopardy

More than 4,600 GPs demand Health Secretary takes action to address GP pressures that are impacting on patient care

Our members say the government needs to address the surging workload and workforce pressures facing GPs and their teams that is impacting the care they are able to deliver to patients - and prevent a potential mass exodus of nearly 19,000 GPs from the service in the next five years.

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We are calling on politicians and decision makers with responsibility for the NHS in England to commit to a bold new plan to provide GPs and patients with the support that they need.

This should include: 

  • A new recruitment and retention strategy that allows us to go beyond the target of 6000 more GPs, backed by a £150 million annual GP retention fund, increasing the number of GP training places by at least 10% year on year, and changes to the current visa rules to make it easier for international GP trainees to stay and work in the UK
  • An NHS wide campaign to free up GPs to spend more time with patients by cutting unnecessary workload and bureaucracy, including through a review of contractual requirements and improving coordination between primary and secondary care
  • Improving patients’ experience of accessing care by investing in a new suite of IT products and support for practices, making it easier for patients to choose to see the same GP or the next available member of the team
  • Allocate a bigger share of the NHS budget to general practice to return funding to 11% of total health spend - with £1 billion additional investment in GP premises, more funding for practices serving deprived communities, and extra money for primary care networks to provide preventative care and promote population health

If fully implemented, we believe these changes would mean:

  • Every patient can quickly get the appointment that they need whether it is face to face, on the phone or via video
  • Patients who wish to can book an appointment with a clinician they know and who knows them
  • Longer GP consultations are available for patients who need them
  • GPs are able to play a key role in supporting community initiatives, supporting well-being and helping people lead healthier lives

GPs are working hard to make this vision for our patients a reality, we now need the government to provide GPs and their teams the support they need. 

Download RCGP Fit for the Future - a new plan for GPs and their patients (PDF file, 647 KB)

Our recent survey of GPs paints a worrying picture of a service in crisis.

As a matter of urgency, the Government must deliver a new support package for general practice and start to rebuild the foundations general practice needs to thrive in the future.

We set out vision for the future of the profession in 2019 because we believe that, with the right tools, skills and investment, general practice can continue to deliver world class patient care.

The present crisis in general practice

Our recent survey of GPs paints a worrying picture of a service in crisis. 1,262 GPs responded to our survey between 3 March and 4 April 2022, covering a cross section of doctors in different stages of their career and from across England.

Key findings from the survey include:

  • 68% of GPs say they don’t have enough time to adequately assess and treat patients during appointments
  • 64% of GPs say they don’t have enough time during appointments to build the patient relationships they need to deliver quality care
  • 65% of GPs say that patient safety is being compromised due to appointments being too short
  • 34% say that the IT for their booking systems are not good enough
  • 64% said their computer systems were not able to properly share information with hospitals 
  • 75% of GPs said that encouraging specialists to refer patients to other specialists themselves where appropriate rather asking GPs to re-refer them would make a significant difference to GP workloads.
  • 68% of GPs said that making back-office functions more efficient would make a significant difference to GP workloads
  • Over half of GPs (57%) said that their practice does not have access to the support and guidance to effectively integrate the new staff roles
  • 74% of respondents to our survey said that their practice does not have sufficient physical space necessary to accommodate new staff
  • It is impossible for most GPs to manage the workload required in the time allocated, meaning on average they work 10 hours more a week than their contracted hours
  • 42% of GPs say that they are planning to quit the profession in the next five years
  • 80% of GPs expect working in general practice to get worse over the next few years, compared to only 6% who expect it to get better

We are facing a situation with a falling number of Full Time Equivalent (FTE) GPs looking after an increasing number of patients with ever more complex needs. On average, as of April 2022, GPs look after 2,056 patients - more than 10% more patients than in 2015.

Last year, general practice in England carried out almost 370 million consultations, this is 18.5% more than in 2019.

Over the same time period, the number of clinical administration tasks delivered by GPs in England rose by 28%, up to 107 million in 2021.

This has led to a situation where our members are worried that they don’t have the time to give patients the care they need. To tackle this, we need urgent action to expand the general practice team and cut bureaucracy and unnecessary workload.

There is an urgent need to improve the booking systems and buildings for general practice.

One of the biggest complaints is that patients struggle to get in contact with their GP. Most of this is because demand massively outstrips supply, but the problems are exacerbated because many GPs do not have the right technology for call handling or online booking and a lack of organisational support to improve the way patients access the service.

An improved booking system could also help with continuity of care for patients. For example, we believe all booking systems and processes should allow patients to express a preference between taking the next available appointment or potentially waiting longer to see the GP of their choice.

The current pressure on GPs from politicians, NHS England and even the press is to focus on speed of access. Our members have risen to this challenge: significantly cutting waiting times so that in 2021 over 45% of all patients had an appointment on the day that they contacted their practice and 76% were seen within a week. While speed is important, we also need to consider quality issues such as ensuring patients and practice staff can build a supportive relationship.

There are too many inefficiencies in the system which are wasting doctors’ time and making it harder to give patients the care they need.

We need improvements in IT systems in both secondary and primary care so that they can work better together and improve back-office functions.

The expansion of the wider practice team should lead to a brighter future for general practice. New investment has meant that primary care networks have been able to recruit extra pharmacists, mental health practitioners, nursing and physician associates, physiotherapists, occupational therapists, paramedics, podiatrists and social prescribing link workers.

These additional staff have already contributed to patient care, but more must be done to ensure that we make the most of these staff. Many of our members have reported that they don’t have enough support and guidance to properly integrate these new staff or that their buildings are not able to house them.

This is particularly worrying as we are already facing a chronic shortage of GPs. Despite an agreement from Government that we need 6,000 extra GPs the number of FTE fully qualified GPs has fallen by 1,622 between September 2015 and 2021.

It is just not sustainable to expect that this problem can be solved by piling more pressure on the existing GP workforce. Research by the GMC shows that around a third (32%) of GPs already report that they are at high risk of burnout – this was the highest amongst all doctors, about twice as likely on average as other doctors.

Our plan for a better future

Action to tackle the crisis is required now.

As a matter of urgency, the Government must deliver a new support package for general practice and start to rebuild the foundations general practice needs to thrive in the future.

This should include proposals to:

  • Create and implement an improved IT system which makes it easier for medical staff to share patient records and information about what they need to improve relationship-based care.
  • Eradicate unnecessary bureaucracy in general practice to enable staff to focus on patient care
  • Introduce changes to the way we deal with the most vulnerable patients moving away from the current Quality Outcomes Framework to a system that encourages GPs to focus on those who need care most and cuts out the red tape and box ticking
  • Improve the experience of accessing care, making it easier for patients to choose to see the same GP or the next available member of the team, achieved through investing in better booking system and organisational development
  • Make it easier for international doctors who complete their training as NHS GPs to apply for long-term visas to stay and work in the UK, bringing the situation into line with trainee doctors in other parts of the NHS
  • Allocate a greater proportion of increasing NHS budgets to general practice to return funding to 11% of total health spend
  • Publish a detailed plan to achieve and go beyond the targets of 6000 extra full time equivalent GPs and 26,000 the number of staff in non-GP roles

Fit for the Future: A vision for general practice - 2019 report

General practice is the bedrock of the NHS. It is the first point of contact with the health service and is highly valued by patients. But it is also under immense strain.

If we are to meet the health challenges of the 21st century and put the NHS on a sustainable footing, we need a positive vision for the future of general practice, and to support GPs and their teams to achieve it.

GPs know how to deliver high quality, person-centred care; they know their patients and understand the communities they serve. The core values of general practice are as relevant as ever. However, as patient and professional needs change, we must learn to apply them in new ways.

The College is setting out its vision for the future of the profession because we believe that, with the right tools, skills and investment, general practice can continue to deliver world class patient care and being a GP can be the best job in the world.