Where has GP crisis hit hardest in Suffolk and Essex? One surgery had a single doctor to 7,000 patients
09:17 16 February 2016
Patients in parts of the region worst affected by GP shortages face the “very real possibility” of not being able to access services locally, a doctor has warned.
Our investigation into the challenges faced by general practice in Suffolk and north Essex has revealed a postcode lottery in access to health care, including surgeries where the number of patients for every full-time doctor is more than twice the national average.
At one point, according to figures from the Health and Social Care Information Centre, Caradoc surgery in Frinton had just one doctor looking after more than 7,000 patients, though it has since been taken over by new management and appointed 3.5 full time equivalent GPs. Surgeries in Ipswich, Felixstowe, Framlingham, Clacton, Colchester and Lowestoft have all had patient to doctor ratios higher than 2,500 to one since September 2014.
NHS England claims to be working with local organisation to address the staffing shortages, while Suffolk’s GP Federation has put together a plan to attract newly-qualified medics to the region. However doctors in some of the worst-affected towns say a more serious overhaul is required.
Simon Sherwood, a GP at East Lynne Medical Centre in Clacton, said it was now “impossible” to recruit doctors to his practice, claiming that even locum posts advertised at £1,000 a day had failed to attract applicants.
He warned the difficulties in recruitment meant there was a “very real possibility” primary care in the town could be completely wiped out within six months, meaning patients would be unable to see a doctor locally.
“Clacton is facing a massive systemic failure in primary care,” he said.
“I don’t think people quite realise how close to the brink we are and I don’t think anyone has any plan or idea about what to do.”
Earlier this year we reported that several practices in Clacton had applied to stop admitting new patients because of staffing issues, which Dr Sherwood said were now worse than ever.
The HSCIC figures show that during the past 18 months at least 10 practices in the region – including three in Clacton – have had doctor-patient ratios of 1:3000 or higher, compared to a national average of around 1:1500.
Chaand Nagpaul, chairman of the British Medical Association’s GP committee, said the figures from Suffolk and Essex “highlight the reality of the workforce crisis facing general practice”.
General practice throughout the UK is reported to be attracting too few new recruits while many experienced doctors are retiring early.
Less than a quarter of medical trainees said they intended to pursue a career in general practice, according to the Health Education Board, while recent research from the University of Bath said nearly half of all GPs leaving the profession in England between 2009 and 2014 were under 50.
The study compared the situation faced by GPs to “boiling frogs”, in which pressures had slowly built up to a point where many GPs no longer felt they could continue.
Billy McKee, a member of the Ipswich and East Suffolk Clinical Commissioning Group’s governing body, and a GP at Walton Surgery in Felixstowe, which has one of the highest patient to doctor ratios in Suffolk, said the service was only surviving on the “good will of the profession”.
He claims to regularly work 14 hour days, with the managerial pressures of running a surgery accounting for much of the burden.
Dr McKee said many GPs were taking salaried positions rather than working as practice partners to avoid the administrative “bureaucracy” now associated with the job.
“We’ve decreased the number of experienced doctors who are providing the service and those who are left are trying to compensate by working longer hours,” he said.
“But the amount of compensation that they can provide is getting less over time.
“We’ve got a much smaller workforce that we are going to have to deploy in a completely different way in order to provide a service that is sustainable.
“That’s a big challenge and it’s going to require blue sky thinking.”
The recruitment problem has been compounded by growing patient numbers.
In the Ipswich and East Suffolk CCG region, the number of registered patients increased by 3.1% between September 2014 and November 2015, according to HSCIC figures, while at some practices, such as Barham and Claydon, there was an increase of 25% during that time.
MP for Central Suffolk and North Ipswich, Dan Poulter, who is a qualified doctor, said he had been working with GPs in Claydon to support the creation of a new surgery to meet the increased demand posed by new housing.
Rachel Helliar, practice manager at The Swan Surgery in Bury St Edmunds, which had a ratio of more than 2,000 patients per GP, said the last 12 months had been the busiest in her 19 year career, with increased waiting times for routine appointments.
“It was always busier in winter during the flu season, but while there used to be a let up over the summer that just does not happen any more,” she added.
“There’s more demand on services and patient expectations can be unrealistically high.”
‘Skill mix’ helping surgeries to meet demand
The ratios of doctors to patients at surgeries across Suffolk and north Essex were calculated using figures from the Health and Social Care Information Centre’s most recent workforce census report and NHS Choices.
While the ratios give an indication of some of the pressures facing general practice in the region, health professionals have said there are other aspects of care that need to be considered.
Suffolk GP Federation’s Simon Rudland said GP teams were “innovating to help meet the demands of their patient populations”, by providing a “skill mix” of nurses and doctors, as well as physiotherapists, pharmacists and mental health workers.
“We want more GPs in Suffolk,” he said.
“We also understand there are other amazing health professionals that can work alongside GPs to help our patients.”
The figures also do not include locum workers, which many practices use to fill temporary or long-term vacancies.
Rachel Helliar, practice manager at The Swan Surgery in Bury St Edmunds, said there was a misconception that locums were costly and meant patients did not get continuity in their care. She said her practice used the same locums on a regular basis so they were familiar to the patients and paid a fixed rate.
With staffing levels fluctuating regularly, some of the practices with particularly high ratios of patients to GPs said they had since appointed additional full time doctors.
Caradoc in Frinton was taken over by Anglian Community Enterprise (ACE) and now claims to have increased its number of full time equivalent GPs from one to 3.5. Hawthorn Drive in Ipswich said it had increased its number of FTE GPs from 2.667 to three.
Patients continuing to receive ‘safe and effective health care’ despite shortages
Health commissioners in the region say they are working together to address the pressures in general practice.
NHS Ipswich and East Suffolk and NHS West Suffolk CCGs said a growing population and ongoing recruitment issues had placed an increased demand on services. However, a spokesman added that GPs and staff worked hard for their patients, which was reflected in a recent satisfaction survey showing that 88% of people rated their experience as good or better – a higher rating than the national average.
“Although the overall GP: patient ratio in Suffolk is slightly above the national average, patients are continuing to receive safe and effective health care,” the spokesman added.
Sam Hepplewhite, chief officer at the North East Essex CCG, said she was aware of the “significant shortage of GPs in our county, particularly in some of our coastal practices”, which created difficulties in accessing a doctor when needed.
She said a workforce development centre had been launched to promote primary care careers.
“Shortages in the primary care workforce are national problems, but we will do everything possible to improve our local situation,” she added.
Tessa Litherland, director of contract management for the Great Yarmouth and Waveney CCG, said the group had produced and an innovative “strengthening primary care development plan”, which identifies ways to help manage increasing workloads while making sure primary care resources are used efficiently.
“One such example is the work we are doing to support practices to work corroboratively and explore how different staff roles can be used to support GPs, such as by developing pharmacist roles in GP practices,” she added.
Christine Macleod, medical director for NHS England (East) said the organisation worked with practices, CCGs and the local medical committees to address the challenges in recruitment in Suffolk and north Essex.
“Nationally NHS England, Health Education England (HEE), the General Practitioners Committee (GPC) and the Royal College of General Practitioners (RCGP) have produced a 10 point plan to building the workforce with measures such as developing other health care professionals to work in primary care, for example clinical pharmacists,” she added. “NHS England and its local partners are committed to implementing this plan in the East.”