Expecting GPs to plug workforce gaps risks ’killing primary care model’, warns GMC Chief Executive

Waiting for more GPs to plug healthcare workforce gaps won’t work, and ‘risks killing’ the UK’s primary care model, the Chief Executive of the General Medical Council (GMC) has told an audience in London today (Wednesday 22 March).Speaking at the Pulse Live conference in the capital, attended by GPs from across the UK, Charlie Massey described the current situation as ‘intolerable – both for patients, who feel that their needs aren’t being met, and for GPs themselves, who are unable to provide the quality of care they want to provide for their communities.’

GMC data shows that trends across the board for all groups of doctors are worsening. But GPs report greater pressure, with more than three quarters of their days being described as ‘high intensity’, a significantly higher proportion than specialists. They are also more likely to report challenges in meeting patient need and are at highest risk of burnout across all groups of doctors.

He told the conference that these pressures may explain why more and more doctors are taking hard steps to leave the profession, ‘just as the need for care is mounting’.

He said: ‘All of this tells us that just expecting more GPs to plug the gap will not give us the sustainable and long-term answers we need. Instead, it risks killing our primary care model altogether.’

But, changes to the way primary care is structured could offer part of the  solution for GPs ‘struggling to cope with the unprecedented demand for care’, Charlie Massey told the event.

He said specialty and associate specialist (SAS) doctors – doctors who do hands-on work but are not in training to become a consultant or a GP – should have wider opportunities, including being able to work alongside GPs in primary care.

‘It’s true that there isn’t a ready-made pool from which we can pluck enough GPs to fill the primary care gap. 

‘But what we do have is a sizeable source of experienced talent in the form of SAS doctors, many of whom are itching to do more with their skills.’

While GP growth has been described as ‘sluggish’, SAS doctors have grown at ‘six times the rate’ of GPs. They’re also highly skilled, with 83% having ten or more years of clinical experience, according to GMC data.

However, ‘bureaucratic barriers’ block SAS doctors from applying their relevant skills to primary care. The Performers List, which determines which doctors can work in primary care currently restricts this. Charlie Massey said changing the criteria could allow SAS doctors to work alongside GPs in complementary roles.

He described a potential new ‘SAS grade’ in primary care: ‘One formulation could involve having a SAS doctor with a particular specialism, such as in paediatrics or elderly care, to work within that area of practice in a primary care setting. Another would be SAS doctors skilled in emergency care being used to triage patients.

‘This would allow GP time to be freed up, so they could focus their time where their skills and expertise are most in demand.’

But he made clear such roles would not be a substitute for GPs or for their expert set of skills. Instead, SAS doctors would work alongside GPs in complementary roles. 

He said: ‘If we get this right, we can open up primary care to a new part of the medical workforce, using the skills of SAS doctors in combination with the wider team to benefit patients.’

Next steps included determining how these roles could be safely developed to contribute to the primary care system. He said: ‘The devil is in the detail, and the mechanics of how these changes play out on the ground will require careful thought and attention. That includes how SAS doctors will be supported and supervised by experienced GPs, without increasing their workload.’ 

Charlie Massey concluded: ‘Evidence tells us that primary care is in dire need of such a change. Doing things as we’ve always done will not create the sustainable workforce we need. It threatens the very survival of our primary care model.

‘To sustain general practice fresh thinking is needed. We at the GMC, working with partners across the system, are committed to playing our part.’ 

Charlie Massey’s speech to the Pulse Live conference in full. 

Ends