NHS general practice is in terminal decline
For those of us born abroad, the NHS is an enigma. A public service elevated to the point where Olympic opening ceremonies extol it and the British people stand outside their homes to applaud it is not something we see in much of the rest of the world. Ask any Brit about this, and you will tend to get an earnest explanation that the NHS is the only thing standing in the way of an American-style health system where the innocent are left to die in the streets and the elderly need to cross the Canadian border to afford pharmaceuticals. This allows the shortcomings of the system to be explained away as just a matter of funding, and the structure to be considered holy writ.
It is astonishing how badly this aligns with reality. News of NHS failings is a near-daily occurrence. Earlier this week, we learned that eye patients were going blind because of backlog delays. And a Health Foundation study released today appears to show that, once again, the NHS is close to breakdown – this time in the family doctor and General Practitioner sector. Brief and rarely in-person GP appointments, high levels of stress and unnecessary levels of burdensome administration have brought satisfaction in GP practices to the lowest level of any country surveyed. Across ten high income countries, UK patients were the least likely to get face-to-face appointments. This will sound all too familiar to anyone who has tried to see a GP in the three years since the first lockdown, the anniversary of which we are about to mark.
The concern is that we will learn the wrong lessons from this report. Despite the negative publicity around short or telephone-based appointments, there is nothing inherently wrong with evolving the length or format of GP interactions. Changing technology and improved access to it could allow GPs to quickly carry out a larger number of brief phone appointments for cases considered lower risk. There is no objectively perfect length of GP appointment, and it could be the case that our, and Germany’s, average length of 10 minutes is an indication of efficiency rather than failure when compared to Sweden's 25 minutes.
But the problems in GP care in Britain are very real – if not very not new. Each previous government has done a little more to reduce the link between service supply and increasing demand for GPs. The Blair Government’s willingness to give in to union demands created a cadre of GPs who work fewer hours for more money. The Cameron and Osborne pension reforms reduced the incentive for GPs – who, we should remember, are self-employed – to keep working into their later lives. These failures of government sit alongside a gradual shift from small local surgeries where a doctor knows their patients personally to larger offices where patients have to use whichever doctor is available, allowing for no personalised service or growing understanding of an individual’s conditions.
Payment systems are now based on patient lists rather than actual workload. The wider NHS funding model provides no incentive for low-risk patients to self-triage, instead arranging to see the GP for ailments that could be handled at home. Similarly, there is no financial motive to attend appointments, despite repeated suggestions that some form of deposit might be required.
And worst of all, the government insists on attempting to centrally plan the supply of doctors, yet professes surprise when it falls short of demand. The time has come for a radical rethink of who can prescribe medicine and who can provide basic health care, and an effort to break down the occupational licensing regulations that artificially keep medical numbers low. This includes allowing physician and anaesthesia associates to prescribe independently, increasing the role of pharmacists in primary care and redirecting university funding to provide more medical places.
There can be no question that the current system is failing to support the efforts of NHS staff. They are trapped within a failed, socialist system. Eight out of ten GPs are apparently dissatisfied with the level of administrative work they need to undertake as part of their role. Overregulation means that doctors spend less time with patients, and directly contributes to the current shortage of appointments. And many GPs are switching to part-time status, with one recent survey finding 58.4 per cent are working six half-day sessions or less.
Aneurin Bevan once said that he was able to convince family doctors to support the creation of the NHS because he “stuffed their mouths with gold”. Today, the issue is less one of money, and more one of ending the bureaucratic roadblocks to letting GPs just get on with treating patients. But it’s more likely politicians will choose instead to pay lip service to this latest report and allow the crumbling of the failed GP model to continue.
Sam Collins is head of the Free Market Forum
