‘Will I Be Able to See You Next Time?’

Or… “Why patients miss having a regular doctor, and how the new junior doctor contract risks making the situation worse.”

Despite being nearly thirty, married for nearly a decade, with two children, I am a “junior” doctor. Technically, I am a GP Registrar. It’s written on my door, and none of my patients understand what it means. I often get the joke “Does that mean you can marry us after you’ve listened to my chest?”.

They always follow this up with the same question: “Does that mean that you are staying here long term…” There’s always a look of hope in their eyes; that I can be a familiar face who knows them; a traditional family GP; a doctor, and a friend.

General practice has changed dramatically over the last 20 years. Practices were commonly run by one or two partners. My training practice has more than 10 partners. Getting an appointment is a scramble of ringing continuously at 8am – hoping to get lucky today – and there’s no guarantee you will see the same doctor each time.

I know that patients are suffering from this lack of continuity: because they complain to me about it. It is no exaggeration to say that 5 patients each day mention how hard it is to get an appointment. Sometimes, on a day when I’m frankly fed up with nodding defeatedly and apologising, I explain why things are changing…

“Why is it so hard for me to get an appointment, doctor?”
You see, Mrs Jones, these days people visit their doctor more often than they used to.

In 1995, on average, a patient would see their GP 3.9 times per year. In 2008, this had risen to 5.5 times. If that trend has continued, in an average practice of 9,000 patients, that would mean a practice will need 22,153 more appointments in 2016 than they did in 1995.

A GP will see around 40 patients a day – although some will see many, many more than this. To meet people’s desire for seeing a GP, every practice would need 3 new GPs. This is the reason nurses have become so vital in GP practices; they help to share the burden of extra appointments.

“Why don’t we just hire more GPs, doctor?”
Unfortunately, Mrs Jones, there aren’t as many GPs as there used to be.

When I applied, 4 years ago, GP training was relatively popular, and there were 30 trainees in my year, locally. This year? We have 7. In London, the problem is less extreme, but it has been devastating across the rest of the country. My colleagues in Chesterfield have just 12 trainees; Lincoln, just 4. And Bassetlaw? Bassetlaw have no new GPs being trained this year. Overall, 30% of General Practice training posts remain unfilled in the UK.

To make the problem worse, GPs are retiring much faster than replacements are being trained. In a recent survey, more than a third of all the GPs in the country plan to retire in the next 5 years – and many others plan to go part time!

Just to keep numbers stable, we would need to graduate 4,000 new GPs a year. This year? Only 2,732 new trainees started GP VTS training, a figure that’s reducing annually. We are heading for an absolute crisis, a shortfall of tens of thousands of GPs across the country.

“Oh dear doctor. What can be done?”
Its a difficult problem Mrs Jones, and no one really has an answer. But there are some simple things that need to be addressed:

We need more medical students. At the moment, there are only 6,800 places in medical schools each year in the UK. In 2007… there were 7,300! Why, oh why, is that number going down? We would need 58% of those students to graduate and become GPs in order to address the crisis that is happening. That would leave the rest of the health service with just 2,800 a year – or just 2.5 new doctors annually for each of our 1069 hospital sites.

We need more encouragement to junior doctors. Jeremy Hunt has tried to unilaterally impose a wildly unpopular new junior doctor contract. There are fears of increased normal work hours, uncertainty about pay cuts and, most worryingly, a very forceful attitude that is leading to a strike tomorrow by junior doctors. Right now, junior doctors need to decide whether to apply for specialty training: primary care is going to see even worse recruitment unless the uncertainty is resolved quickly and positively.

“Is there anything else we can do, doctor?”
Well, Mrs Jones, I’m glad you asked that…

We need to use our brains. The patient before you attended because he had a spot on his nose. Since yesterday. Did he really need to see me? When I work in A&E, I regularly see people who have mild sunburn. I see patients who’ve had a sore throat for 3 days and saw their GP earlier today, but want a second opinion. I’ve seen parents at 9pm because their 2 year old hasn’t gone to sleep yet.

We seem to be afraid to say it, but the NHS needs patients to take some responsibility for minor ailments. Every doctor you will see has a hundred stories about patients attending needlessly. We need a prescription of that very British quality: good old common sense.

If we are going to save the NHS, we need to work together, doctors and nurses, patients and politicians. Its our health service, and its up to us to keep it healthy!

Now, Mrs Jones, let’s get back to you. How can I help you today?
“Well you see doctor, my nose has been running since Monday. I went to the Urgent Care Centre last night, but its not better yet. I thought maybe you could give me some antibiotics…”