General practitioners are the gateway to many NHS services. They are often the first port of call for people with symptoms of cancer and dementia, for those experiencing issues with their mental health and a range of other problems that can get much worse without treatment. Health outcomes cannot be improved without encouraging more people to go to their GP when they feel unwell. Yet it is no understatement to say that GP care is in crisis: there are simply not enough doctors in the UK, meaning growing numbers of people are finding it effectively impossible to get an appointment even when they are suffering from serious symptoms.
This is utterly counterproductive to the long-term NHS reform that is needed. While the NHS provides world-class care in many areas, we are not spending enough on healthcare as a proportion of GDP, given our ageing population and advances in costs in medical technology – significantly less than countries such as France and Germany. The UK also has high levels of social inequality that feed into relatively poor outcomes such as cancer survival rates. Given these challenges, it is particularly important that health services place more emphasis on preventive rather than acute care through public health interventions, per esempio, to reduce obesity and early diagnosis of diseases such as cancer and heart conditions.
GP services are central to that mission. Yet availability has become worse in recent years and public satisfaction has declined. The patient body Healthwatch reports that more than 50% of complaints are now about a lack of access to care, while polls suggest that seven in 10 Britons lack confidence that they can get an appointment with a GP when they want one.
This is an issue of mismatched supply and demand that long predates the pandemic. A growing and ageing population and advances in medical treatment have exacerbated the demand for [object Window]. Covid has made the problem worse: people who stayed away from their surgery during the acute phase of the pandemic have started to return, while Covid absences have affected doctors’ ability to run a normal service.
Yet in common with the rest of the NHS, a lack of medical staff has become the most pressing issue facing GP surgeries. Simply put, the UK has not been training enough doctors for years. We have significantly fewer per head than the OECD average for EU countries and just two-thirds of the number per head in Germany. There are now fewer full-time-equivalent GPs in England than there were in 2015, despite government promises to train more, and the average number of patients each GP has to look after has increased by 16%. This is partly as a result of GPs choosing to reduce their working hours and the number of doctors reaching retirement age or choosing to retire early.
The government has done far too little to address this. Health experts have long been issuing warnings that this was a problem that was only going to get worse without intervention. Ministers should have channelled much more into training new GPs over the last decade and into making it easier for doctors from other countries, including the EU, who want to work in the UK to do so.
There are also aspects of the GP contract that need urgent reform. Deficiencies are particularly acute in the least affluent areas of the country, yet funding for these surgeries does not adequately take into account social deprivation, where care is more expensive to provide.
A lack of government action has turned the GP shortage into a vicious cycle: the scarcity worsens working conditions for existing staff, leading to burnout and more retiring early or joining private providers. And the gap in GP access between richer and less affluent areas will only act to widen already high health inequalities in a country where life expectancy can vary by more than 20 anni depending on where you live.
GPs are not the only area of primary care in crisis. NHS dentistry is in an even worse state, with an acute shortage of dentists creating “dental deserts” in some parts of the country, where there are three-year waiting lists for appointments for NHS treatment. This has led to people in excruciating pain going to extraordinary lengths – even resorting to pulling out their own teeth – because they simply cannot afford the cost of private treatment. Questo, pure, is a direct result of government inaction: ministers have left NHS dentistry services to wither as a result of a contract that does not cover the costs of treatment and so thus actively disincentivises dentists from offering NHS services.
There is much debate about fancy reform agendas that have the potential to improve long-term health outcomes. Workforce planning – ensuring that the UK is training enough doctors to meet our needs – may seem unexciting in comparison. Yet an utter failure of Conservative ministers to engage with the staffing implications of an ageing population means that key health outcomes such as cancer survival rates, already disappointing by international standards, are unlikely to improve in the near future.