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Tuesday, 9 July, 2002, 11:23 GMT 12:23 UK
Postcode lottery in GP services
GP
GPs are under pressure
The service provided by Britain's GPs is highly variable across the country and could get worse if recruitment problems intensify, a report says.

Inner city areas are more likely to have fewer GPs and poorer facilities, the study by the Audit Commission found.

Oxfordshire, for instance, has twice as many GPs per head of population as Gateshead - and twice the level of funding.

The report says GP numbers are increasing, but not fast enough to meet targets set out in the NHS Plan.

The study also found:

  • Nearly one in 10 premises do not meet basic minimum standards such as having a sink in treatment rooms. Most of these are in deprived urban areas.
  • One in five Londoners wait three or more days to see their GP, compared to one in eight patients elsewhere in the country
The report says that shorter hospital stays and increasing numbers of elderly patients are placing GPs under more pressure.

This is further intensified by the demands of having to monitor more specialist drugs and treatments, and by patients who are demanding a quicker service and more say on their own care.

At the same time, general practice is experiencing an increasing staffing problem:

  • In some inner-city areas one in five posts are vacant.
  • In some areas 50% of GPs are over the age of 50, and close to retirement

Latest figures from the Department of Health show GP numbers increased by 170 between September 2001 and March 2002 to a total of 30,860.

The NHS Plan, published in July 2000, promised 2,000 extra GPs by 2004.

In April 2002, this was updated to 15,000 extra doctors by 2008, although ministers did not specify how many of these would be GPs.

The report says that plans to modernise the service, which include a new employment contract for GPs and greater devolution of NHS funds down to GP-led groups, should improve matters.

However, it says: "Too much may be expected too fast of general practice, given a history of patchy investment and current staffing problems.

"Many practices are struggling to deliver today's agenda, given the problems in recruiting and retaining staff."

Large practices

The report also found that the number of GPs working in practices with six or more partners has grown from one in five in 1988 to one in three in 2001.

Larger practices may offer more patient choice and higher-quality services, the report says, but a higher concentration of services in fewer centres may mean that patients have to travel further to be seen.

"This may not suit all patients," it says.

Sir Andrew Foster, Audit Commission controller, said: "Most people have a high regard for GPs and consider they are well served.

"They want practices everywhere to provide the modern, responsive service achieved by many.

"But our report shows that not all people have the same access to quality GP care as others."

The report calls for better use to be made of nurses and community pharmacists to help relieve the pressure on GPs.

Doctors's response

Dr John Chisholm
Dr John Chisholm said general practice was under-funded
Dr John Chisholm, chairman of the BMA's General Practitioners Committee said more than nine out of ten NHS consultations were carried out in general practice on a budget equal to only one fifth of the NHS spending bill.

He said: "The Audit Commission report rightly highlights the pressures GPs and their staff are working under and the dire recruitment and retention problems they face.

"Family doctors will empathise with the statement in the report that many practices are struggling to deliver today's agenda."

Dr Chisholm said the new GP contract would make sure that the money going into general practice matches the needs of patients.

Mike Stone
Mike Stone said the only solution was more GPs
Mike Stone, of the Patients Association, said it was unacceptable to have to wait three days to see a GP.

"We need to look at the actual job of being a GP, make it more attractive to people, give it some career structure so you are not always going to be a GP, that you are actually going to progress."

However, he said the only real way to address the problem was to recruit more doctors to general practice.

The Department of Health said it had introduced a range of measures to improve GP recruitment and retention.

These include golden hellos for new recruits, childcare support and additional payments to doctors who delay their retirement.

See also:

01 Jul 02 | BMA Conference
03 Jul 02 | BMA Conference
17 Oct 01 | Health
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