Health leaders have warned that the total number of GPs working within the NHS system has yet to return to 2015 levels.
This is based on official headcount and full-time equivalent data over the final quarter of the 2016/17 financial year.
The figures would seem to indicate that the NHS is far from being on track to meet the Conservative party’s pledge of training and retaining an additional 5,000 GPs by the end of the decade.
This policy appeared in the recent Conservative election manifesto.
NHS Digital, responsible for publishing the data on the GP workforce, did indicate that comparisons should be treated with caution owing to new data organisation techniques having been utilised.
Furthermore, seasonal changes in workforce data could also have an impact on figures, with these currently being unknown.
Nonetheless, official data indicates that the number of GPs in England fall from 41,865 in September 2016 to 41,475 in December; a fall of 390, or 0.9%.
Commenting on the issue, GPC education, training and workforce lead Dr Krishna Kasaraneni, suggested that the figures demonstrated that the Conservative government has fundamentally failed to meet its commitments to the NHS.
“These figures demonstrate the failure of politicians to uphold their pledges to deliver the GPs necessary to provide the number of appointments and sustainable service that patients deserve. The overall number of GPs working in England has dropped since 2015, which leaves the NHS a considerable distance short of the current targets for the GP workforce. There is little prospect of the promised 5,000 additional GPs materialising anytime soon.”
Kasaraneni went on to label the situation as a crisis, and called on the winner of the next general election to address the situation immediately.
“This continued workforce crisis has left many GP practices unable to properly staff their surgeries at a time when local services are struggling to cope with rising patient demand and flat lining budgets. A recent BMA survey showed that a third of GP practices had vacancies left unfilled for a year. The next government must ensure that we have a properly staffed service that can meet the needs of patients.”
Meanwhile, RCGP chair Professor Helen Stokes-Lampard reflected that there is currently little evidence that the NHS will be able to meet the Conservative target for GP recruitment.
“Of course any rise in GP numbers is encouraging, and we are seeing a small rise since the last figures in December – but we are still way off the GP Forward View target. Workload in general practice is soaring – 16% over the last seven years according to the latest research – yet our workforce has not risen in step, and is now actually reducing. This isn’t acceptable.”
Wales is the destination for the UK’s first high-energy proton beam machine.
Proton Partners International (PPI) delivered the technology to its new location in Newport.
The cancer-treating machine will be located at the Rutherford Cancer Centre.
PPI proclaims the technology to be the “most-advanced piece of cancer machinery” in the UK.
It is hoped that the proton beam machine will transform the treatment of 500 cancer patients annually.
This will be a real boost for Newport and could lead to the technology being implemented in other areas of Britain.
Currently, only low-energy treatment is available in the UK for rare eye cancers.
The Welsh government has proclaimed the new deal, indicating that the new form of therapy will be available to NHS Wales patients by the end of the calendar year.
Commenting on the deal, PPI chief executive Mike Moran suggested that it represents the biggest breakthrough in cancer treatment for many years.
“This is the most strategic health project in this country in decades. It’s significant for the people of Wales to have high-energy proton beam therapy available.”
PPI asserts that the treatment has the potential to improve clinical outcomes and the overall cancer experience for patients.
It is common for those in Britain suffering from cancer to require six weeks abroad in order to receive proton beam therapy in foreign settings.
And PPI has confirmed that the treatment will be available to medically-insured private patients, self-paying patients and patients referred by the NHS.
However, there is still some debate over to what degree the technology will be available for NHS patients.
Proton beam therapy has the ability to treat invasive cancers such as spinal tumours, while also lowering the risk of damaging surrounding tissue.
Currently, 140 patients are sent abroad from across the NHS in order to receive this treatment on an annual basis, at an expense of over £1.5 million.
Experts believe that the Newport treatment centre will halve this figure.
The Rutherford Cancer Centre opened in February and currently receives referrals for conventional cancer treatments.
And PPI is already constructing three more proton beam centres in Britain, located in Northumberland, Reading and Liverpool.
Government officials have been accused of a cover-up over what is believed to be a delay in the publication of NHS trust deficit figures.
These will now emerge after the general election, but opposition parties suggest that this has been deferred in order to bury bad news.
The data will outline the full scale of the deficit posted by trusts in England in the latest financial year.
And this had been due for publication two weeks ahead of the general election, which will take place on 8th June.
But the figures will not be released as scheduled due to “purdah rules”.
These regulations ban the Government from making any kind of announcement about new or controversial initiatives or laws that could sway the outcome of the vote during an election campaign.
When NHS Improvement publishes the figures, it is believed that an annual deficit in excess of £850 million will be reported.
This is certainly not good news for the NHS, which has failed to meet its financial targets once more.
And the delay of this data has brought a strong response from opposition parties.
Labour’s shadow Health Secretary Jonathan Ashworth suggested that the delay was nothing short of deliberately deceitful.
“The state of the NHS is the big issue of this election. We know waiting lists are getting higher and higher under this Government and many hospital trusts are struggling with their deficits. It’s a cover up to deny the public the true picture of the NHS. We demand full transparency so everyone knows the real state of the NHS when casting their vote.”
And Norman Lamb, the Liberal Democrat’s health spokesperson, added it would be “wrong to try to hide this vital information” until after the public go to the polls on 8th June.
“The public deserves to know the scale of the financial crisis facing the NHS before they vote. The Conservatives are providing far less funding than independent experts have warned the NHS will need. The consequences will be dire for patients, with longer waits and lower standards of care.”
This is not the first time that Conservative policy towards the NHS has been accused of being fundamentally deceitful.
The British Medical Association has been particularly critical of the pledge of the Conservative party to provide an extra £3 billion for the NHS, asserting that this included money previously set aside for precisely this purpose.
“The extra £8bn touted in this manifesto for the NHS is smoke and mirrors,” Dr Mark Porter, the chairman of the BMA council, commented.
LMCs have called on the GPC to push for general practice to be added to the UK shortage occupation list to help practices struggling with long-term vacancies recruit GPs from overseas.
Delegates approved a motion at the LMCs conference urging the UK Visa Bureau to add general practice to the UK shortage occupation list so they can employ doctors from outside of the EEA to fill vacancies.
Proposing the motion, Dr Henry Akpabio from Redbridge LMC said many occupations – including nurses, paramedics, artists, dancers, choreographers, musicians and chefs – are already on the list.
Other medical specialties, including emergency medicine and psychiatry, are also already on the list, he said.
Akpabio told the conference that the recruitment situation is about to get serious for the NHS.
“This list is an official list of occupations for which there is not enough resident workers. Employers who wish to recruit outside of the EEA and Switzerland have to go through this list to see whether that vacancy is approved so that they can issue a certificate of occupation.”
And the doctor went on to assert that general practice is particularly under threat.
“We want general practice on the list because it meets all the requirements. We have a diminishing workforce and more and more are retiring earlier due to the present workload, so we need to employ people from other places.”
Dr Mark Sanford-Wood of the General Practitioners Committee stated that the GPC had already pushed for this and “would very warmly welcome you supporting this to empower us” in negotiations.
The full-time equivalent GP workforce had dropped by 445 in the three months to December, according to official figures.
This is despite the fact that the government has promised to recruit a further 5,000 GPs by the end of the decade.
NHS Confederation has indicated its belief that there is an onus on government ministers to address mounting disquiet among NHS staff regarding pay and recruitment.
Indeed, the authoritative organisation suggests that a full-blown staffing crisis is on the cards if the government fails to satisfactorily respond.
Niall Dickson, chief executive of NHS Confederation, spoke out on the issue at a time when it is predicted that 2,000 European-born doctors could leave the NHS system owing to concerns over Brexit.
Writing in The Guardian newspaper, Dickson suggested that nurses complaining about the capping of pay increases are justified in their perspective, and called on the government to rethink the effects of stagnating pay on staff morale.
“There may now be a case for looking again at pay. Given the financial and demand pressures on the service in recent years, some pay restraint has been necessary and inevitable. But it is also obvious there will be a limit on how far this can be taken before it affects recruitment and morale.”
Interestingly, the chairman of the NHS Confederation is Stephen Dorrell, a former Conservative health secretary.
Just days ago, the Royal College of Nursing announced that nearly 80% of its members backed strike action over pay, with over 90% favouring industrial action of some sort.
And Dickson highlights this survey as being indicative of a wider malaise within healthcare staffing.
Nearly a quarter of NHS trusts now have a vacancy rate for registered nurses of more than 15%, Dickson notes.
And specialties such as psychiatry face a particular challenging task in order to fill training places and vacant posts.
This is only likely to exacerbate given the greying population and its resultant demographics.
Today, Dickson believes that some areas of the country are finding it extremely difficult to recruit doctors effectively, with hospitals being propped up by trainees as consultant posts are impossible to fill.
The Royal College of General Practitioners believes that staff problems will be exacerbated as EU-trained doctors ultimately return home following Brexit.
Dr Helen Stokes-Lampard, chair of the RCGP, recently spoke out on the problem.
“We risk losing well over 2,000 family doctors from the NHS if their position is not secured as part of Brexit negotiations, and that is just not safe or acceptable. Our greatest fear is that hardworking, dedicated doctors from EU countries will simply cut their losses and leave, instead of waiting to have their fate determined for them. This would be a disaster for patient care, and it also makes long-term workforce planning for GP practices impossible.”
The Labour party has ensured that the NHS is a major talking point of the general election, with Jonathan Ashworth, shadow health secretary for the party, indicating that it will end pay caps for public sector workers, including healthcare staff.
“The NHS should be an absolute priority in the Brexit negotiations. The Tories’ chaotic approach to workforce management in the NHS has already left us thousands short of the number of GPs we need, and we simply can’t afford to lose the 2000 European GPs working here. Labour are pledging…to guarantee the rights of EU citizens working in our health and care system.”
A new GP pilot application is set to play a key role in the future of surgeries, but its founder states that it will never entirely replace human doctors.
Ada enables patients to create a profile, with the software utilising an artificial intelligence engine in order to make a diagnosis.
Personalised reports are provided by Ada, along with the suggested steps.
Patients are able to have a supplementary video consultation with a human GP once the process has been completed.
Ada founder Dr Claire Novorol believes that the app could even save as much as 50% of the average workload of a GP.
And research has already indicated that there is a 90% agreement in diagnosis between GPs and Ada.
With the technology having already been trialled in central London, Novorol looks forward to the “first step of what will be a collaborative and long approach with the NHS”.
The practice is utilising a specialised version of the software for pre-assessment and online consultation.
While there is no particular controversy over this approach, the surgery in question has asked to remain anonymous until the trial has been successfully completed.
A GP from the pilot scheme outlined the benefits of Ada in the clinical environment.
“Having essentially a fully fleshed-out pre-assessment tool is really useful. It saves time in a consultation and there can also be an element of triage there. We’ve had a few patients use it with very simple hay fever symptoms. Ada has suggested this and then they’ve not come in. The patient gets value, but we also get value – patients have gone away and sought more appropriate care or not called us at all. We’re seeing that already.”
The doctor went on to explain how positive he is about the future of such applications, predicting that they will inevitably play a major role in the healthcare system.
“The information gathering has saved some time. We’ve had multiple cases where Ada has asked more questions than we can in a 10-minute appointment. It can go through asking about a lot more history and gather more information than we could have. Without a doubt it’s going to be the future. We are moving towards a digital-first approach – it assists both ends of the GP-patient relationship.”
Finally, the GP called on his colleagues to embrace what he believes to be a particularly valuable form of technology.
“The difficult job of diagnosis and unmet patient health needs are a critically high part of our work and that will be assisted by this. It won’t ever replace the GP face-to-face consultation, but it will shift how a GP works. I would hope a lot aren’t protective about that. With the increasing rate of patient consultations we need help. I would rather they have somewhat intelligent help than an unstructured Google approach – it’s definitely a way forward.”
LMCs are calling for NHS England to be held to account over problems with the primary care support service delivered by Capita.
And it is also suggested that surgeries affected by the poor working practices of Capita should be offered compensation.
LMC leaders have backed a motion which labelled the management of primary care support services by capita as “shambolic”.
With extra workload having been incurred in many cases, LMCs believe that many organisations within the healthcare system should receive financial remuneration.
And LMCs also suggested that NHS England must move to swiftly resolve any difficulties with outstanding payments.
Many GP practices are still owed monies by NHS England, while there are also problems with the performance list according to LMCs.
And the organisation also suggested that problems with the service should be communicated more rapidly and accurately to patients.
Dr Fay Wilson put forward an additional rider to the motion, demanding that Simon Stevens and NHS England be held to account for problems with the primary care support service.
“Let’s put some mustard on our sausage. We should be outraged, not dismayed. The head of NHS England should be held to account for this failure, and we should be saying so. Let’s escalate this to the organ grinder and not keep talking to the monkey.”
While Dr Nicola Hambridge, also speaking at the conference, told delegates that GPs working within the healthcare system have been badly let down by insufficient primary care support, and that this had even led to patients are being at risk.
“Month after month the problems continued. Practice managers lost days of their lives because of the problems, and GPs have lost work because of unnecessary performers list issues. If a GP had failed so often and in so many areas, they would have lost their contract a long time ago.”
Although NHS England has yet to respond to these calls, it has indicated that it is currently considering compensation for any practices affected by negative delivery of primary care support services.
Capita has acknowledged its problems with delivering the NHS services it is contracted to provide, making a statement last year.
“NHS England contracted Capita to both streamline delivery of GP support services and make significant cost savings across what was a highly localised service with unstandardised, generally unmeasured and in some cases, uncompliant processes. We have taken on this challenging initiative and we have openly apologised for the varied level of service experienced by some service users.”
LMCs have warned that GP training must be overhauled in order to prepare registrars to take on partnership roles.
Furthermore, there should be a focus on increasing the number of placements in general practice settings, according to comments made at the annual LMC conference.
Delegates also backed calls for GP training to be geared more towards preparing trainees to become GP partners and principals.
There was also a suggestion that GP training schemes should be extended to at least four years, with two years of this overall process being spent within general practice environments.
Meanwhile, the foundation programme should include mandatory time in general practice, according to comments made at the conference.
GPC policy lead Dr Gavin Ralston backed the policies, suggesting that it would be a sensible direction for general practice to take.
But there was also some disagreement on the appropriate approach for general practice.
For example, Cambridgeshire LMC’s Dr Rebecca Schofield spoke out against the proposed policies.
“GP registrars are entering at a really challenging time and also a time of change. I believe this should be valued. More GPs are making positive choices to work in salaried and locum roles to develop their skills and thrive in general practice. We need GPs to make a positive choice, not to be pushed,” Schofield suggested.
Elsewhere, the motion also asserted that incentives should be created in order to encourage practices to both accept and support foundation year one and two posts.
It was also suggested that the GPC should campaign towards seeing examination fees cut.
Proposing the motion to increase training time, Dr Tom Micklewright from the GPC GP trainee committee suggested that there is clear statistical evidence to support more time for students in general practice.
“Over 90% of patient contact happens through general practice – but some medical students spend as little as three weeks in general practice out of a five- to six-year medicine degree.”
And Micklewright also suggested that there is a strong correlation between time spent in training and the likelihood of graduates opting to work within the NHS system.
Dr Kate Baker from Bro Taf LMC was one doctor who spoke out strongly against the current policy, labelling the lack of time spent in general practice as ridiculous.
“If you had more exposure, then those that remain in hospital will understand us better – they’ll have been there, they’ll know what we’re doing. And those that are exposed to general practice would realise what a fabulous career it is.”
A further motion called for GP trainee portfolios and appraisal toolkits to be kept confidential and protected from use in litigation in the future, following a case last year where this happened against a paediatric trainee.
As the controversies over general practice continue to accumulate, a member of the General Practitioners Committee sessional subcommittee has suggested that GPs should consider boycotting out-of-hours sessions.
Dr Preeti Shukla from Lancashire and Cumbria LMC believes that the scandalous costs related to indemnity should provoke this action.
Shukla spoke at the LMC conference in Edinburgh, where the sessional GP indicated her intention to introduce the proposal to General PractitionersCcommittee members next week.
And the GP suggested that around 100 sessional GPs in England have already ceased working out-of-hours due to what she described as prohibitive indemnity costs.
This represents around 25% of the sessional GPs, and Shukla believes that this is satisfactory evidence in order to illustrate that something should be done immediately.
“We are being forced out of our profession anyway, so why don’t we take action? Out-of-hours is voluntary. If we stop identifying ourselves for out-of-hours then we won’t be able to work in the system and the whole system will collapse. We want this to be an eye opener for the DH that if you don’t do anything about indemnity, we will stop working for out-of-hours,” Shukla commented at the conference.
NHS England has already agreed to reimburse the increase in indemnity costs for all GPs for 2016/17 and 2017/18.
And the authorities have also extended the winter indemnity scheme for GPs, which is intended to help cover the costs for those doctors forced to work out-of-hours shifts over the Easter period.
Meanwhile, the Conservative government has already indicated its intention to reimburse any indemnity cost rises.
This is an explicit policy, included in the Conservative manifesto published this week, with the document promising that “appropriate funding for GPs to meet rising costs of indemnity in the short term while working with the profession to introduce a sustainable long-term solution”.
Nonetheless, many doctors remain unconvinced about the sincerity of the government schemes to tackle this rising pressure on general practice finances.
Despite the bold proclamations of Labour leader Jeremy Corbin, an authoritative healthcare organisation suggests that the share of money for the NHS will decline regardless of which party wins the next general election.
While the Labour Party has made £36 billion investment in the NHS a central pillar of its policy, the Conservative party promises a minimum of £8 billion extra in real terms for the NHS by 2023.
Nonetheless, there is much controversy over ring-fencing, with it currently being unclear which services would be guaranteed under the Tory plans.
Despite an increase in revenue for the NHS, experts suggest that some critical areas of the healthcare system will need to be restrained should the Conservative party scenario come to fruition.
Meanwhile, the Nuffield Trust think tank suggested that even a generous interpretation of the Conservative plan would result in the national income share of the NHS shrinking.
The Nuffield Trust indicates that the figure will recede from the current 7.3% to 7.04% under Conservative rule.
Nigel Edwards, chief executive of the Nuffield Trust, confirmed this calculation.
“Even under a generous interpretation of what will happen to these other budgets, the share of Britain’s national income going to the NHS will continue to shrink, from 7.3% to 7%. The same is the case for the other parties’ proposals as well: we are on course for more than a decade of unprecedented austerity.”
While the Labour spending plans will result in significantly higher real terms expenditure by 2023, this would still represent a fall to 7.23% of GDP.
And despite strong statements from the Liberal Democrats, the Nuffield Trust asserts that the Lib Dem manifesto would barely be better than the Conservative party, seeing spending falling to 7.07% of GDP.
The aforementioned Edwards offered his opinion on the £8 billion pledge made by the Conservative party
“It is unclear how much new money this represents, or exactly when it would come onstream. We do not yet know whether promises of upgrades for buildings and IT will be backed by new spending, (and) the pledge does not apply to the £13.5bn of health funding not held by NHS England.”
The Conservatives’ manifesto also promises “the most ambitious programme of investment in buildings and technology the NHS has ever seen”, but does not set out details on how much extra capital funding will be provided.
Responding to the figures provided by the Nuffield Trust, the Health Foundation absolutely concurred with its conclusions, while also stating that Labour’s plans represented nearly a doubling in the increase in funding compare to the Conservatives.
The Care Quality Commission has rated an independent provider as outstanding; the highest commendation offered by the commission.
Horder Centre in Crowborough, East Sussex, has been rated outstanding overall, with its caring and responsive qualities particularly praised.
Safety and leadership at the organisation was also considered well above average.
Horder Healthcare is responsible for running the organisation, and the private healthcare company indicates that 98 per cent of its outpatient activity and 94 per cent of its inpatients are funded by the NHS.
The centre particularly specialises in orthopaedic and musculoskeletal conditions, treating around 17,000 outpatients on an annual basis.
Inspections took place back in January 2017, with the Care Quality Commission finding that leadership at the centre took “full responsibility and ownership” of care quality and treatment in the hospital.
Inspectors also noted that staff culture is “positive”, while the turnover of employees is also significantly lower than the NHS average, indicating an overall positive culture.
Vanessa Ward, CQC hospital inspection manager, South East, stated that “staff went the extra mile and the care patients received exceeded their expectations.”
In addition to the praise that the Care Quality Commission afforded the centre for its everyday operations, some additional efforts were also lauded.
The centre was recognised for the work it is doing to use its venous thromboembolism (VTE) exemplar status to improve practice in the local area.
This has involved hosting study days among other measures, with the intention of acting as a best practice hub for this critical area of research.
The centre was also praised for its part in the specialist orthopaedic alliance (SOA) to help redesign orthopaedic services as part of NHS England’s national vanguard project.
Aspects of digital services at the centre also received commendation from the Care Quality Commission, with the provider being particularly efficient in offering access to a electronics records relating to community service.
This enabled both general practitioners and hospital staff working with the centre to access up-to-date patient information rapidly.
Nonetheless, despite the glowing verdict of the Care Quality Commission, the centre also had a few areas in which improvements could be made.
The CQC stated that the organisation “should ensure patient temperatures are measured during their operation in line with national guidance”.
Horder Healthcare is also responsible for running The McIndoe Centre and outreach clinics in Tunbridge Wells, Seaford and Eastbourne.
The NHS Confederation has outlined a proposal for the next government to support its bid in transforming the UK’s health service.
Responsible for representing NHS providers and commissioners, the commission is calling for a “clear and credible approach” to funding.
A new officer for Budgetary Responsibility in Health (OBRH) should also be created according to the commission, in order to provide an objective assessment of NHS finances.
The Confederation first called for such an officer back in 2013 and says the case for it has only grown stronger in recent years.
This proposed OBRH would offer analysis on NHS spending and likely pressures, and measure the delivery of productivity by the NHS.
“An expert assessment on efficiency would enable realistic targets to be set and an authoritative basis for holding the NHS account for what is delivered,” the Confederation commented in a statement.
Additionally, the body has appealed for a funding target to “strengthen the principle of economic prosperity” with calls for the NHS spending to develop at the rate of the country’s economic growth.
The target would be up to the next government according to the report.
However, the body suggests that an equivalent measure to France and Germany – which currently requires around £16 billion a year – due tosimilar health expenditure.
The Confederation claims that this target would enable health services and the public to have “more certainty on future health spending levels [and] a target linked to France and Germany would offer reassurance of spending in line with comparable economies.”