Surgeries in parts of Suffolk need 33% increase in GP numbers to cope with patient demand
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Suffolk patients are set to face growing difficulties accessing GP appointments amid warnings the county’s long-running recruitment crisis now poses “toxic” dangers to the service.
As part of an investigation into the future of GP services, doctors, politicians, and GP representatives said today that years of difficulties attracting graduates to the profession together with an ageing workforce and growing public demand had left the service more vulnerable than ever.
Recent figures estimate parts of Suffolk and Essex need to increase GP numbers by a third or more to meet the demands of a growing population by 2020. Meanwhile, clinical commissioning groups (CCGs) insist standards of care in Suffolk remained high, while NHS England said it was working with practices to find solutions to the nationwide shortage.
However, Simon Jones, chief executive of Suffolk’s Local Medical Committee, said the “damage had already been done” resulting in a “toxic situation” that he was unsure how to resolve.
“It’s the worst it has ever been,” he said.
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“Something has got to give and I’m not sure what that will be.”
Nationally, the British Medical Association (BMA) said general practice is under “incredible pressure” and called on the Government to invest more to meet patient need.
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The increased workload faced by GPs has seen growing numbers leave the profession early, according to a survey published this month by the University of Bath, which said 46% of those departing between 2009-14 were under 50.
Matt Piccaver, a GP at Glemsford Surgery in Bury St Edmunds, said the situation in Suffolk was better than some parts of the country, though he warned “large swathes” of retiring doctors could cause problems in the near future.
“We are seeing escalating demand and a declining workforce – I’m not sure how it will cope,” he said.
Earlier this month we reported GP shortages in Clacton meant three of the town’s four practices had stopped taking new patients.
Community leaders in Waveney say shortages there have also begun to affect services, after claiming the forced closure of a medical practice left nearby surgeries struggling with increased demand.
The Care Quality Commission shut Oulton Medical Centre in October due to “serious concerns about the service and the risks it presented to patients”.
Waveney councillor Jane Murray, who represents the Oulton ward, said nearby surgeries were now feeling the strain after being required to take on 5,000 patients displaced by the closure.
“I think they are trying to give the impression everything is hunky dory, but I know the medical staff are struggling,” she said.
Ms Murray said she feared patients visiting local surgeries would be expected to see nurses more often than GPs because of shortages.
Sonia Barker, who represents Pakefield at the county and district councils, suggested the practice closure may have been linked to a bed shortage at James Paget Hospital on January 4, which saw patients told to stay away unless their condition was “life-or-limb-threatening”.
She had already raised concerns the closure of Southwold and Patrick Stead hospitals would place greater strain on James Paget and said she would be asking Great Yarmouth & Waveney CCG to carry out “thorough analysis” of the recent incident at the hospital.
Andy Smith, chief executive at the CCG, said the Oulton practice closure was “very unusual” and claimed the other surgeries had managed “very well”, despite the difficulties. He said the situation at James Paget was due to the increasing demand for urgent care services and not the practice closure.
According to the most recent report on capacity by the Royal College of General Practitioners, thousands of new GPs are needed to meet the country’s growing needs, with practices requiring an average of 25% more full-time equivalent GPs by 2020.
In the Ipswich and East Suffolk CCG area, however, a 33% increase is said to have been required, while in the North East Essex CCG area a further 38% full-time positions need filling.
Sarah Adams, Labour’s health spokesman at Suffolk County Council (SCC) said: “With recruitment down and Suffolk’s population not only growing, but growing older, GP provision is already reaching breaking point.”
Healthwatch Suffolk surveys patients on GP services which found 54% of respondents were positive about their practice despite 38% of comments relating to access being negative. The group also works with practices to identify solutions to patient concerns over appointment bookings.
Michael Ladd, chairman of SCC’s health scrutiny committee, which investigated the GP situation last year, said there were “pockets” in the county where recruitment was a problem, though overall Suffolk was better than many areas.
He called for greater collaboration between health authorities and planners so new large-scale housing approvals included requirements for financial contributions to health services.
Suffolk GP Federation is working to improve the situation
The Suffolk GP Federation says its work to improve recruitment and retention of doctors in the county has helped curb the problems experienced elsewhere in the UK.
Simon Rudland, a non-executive director at the Federation and its leader in recruitment said there were “massive issues” facing general practice across the country. In Suffolk, however, he said the Federation was working “proactively to engage with these issues”.
To attract newly qualified medics, Dr Rudland said the Federation worked to promote general practice as a career to students, while running schemes to encourage newly qualified medics to relocate to Suffolk.
The Federation has also been working with businesses to promote the range of professional careers available in Suffolk so GPs feel comfortable bringing their family here to work.
With many newly qualified doctors choosing to relocate to Australia or New Zealand, where the work-life balance is said to be better, Dr Rudland said the Federation had set up a programme so young doctors could visit other countries and yet still return to Suffolk.
He said the Federation was also working to address the issue of early retirement by helping GPs to become locums or to revalidate, thereby retaining the most experienced members of the workforce.
Health chiefs’ response to the problem
Health chiefs have acknowledged there are GP recruitment problems in Suffolk and north Essex, which they claim to be working to address.
NHS England said it was working with CCGs, and local medical committees to address workforce issues.
The Ipswich and East Suffolk and the West Suffolk CCGs said the county was less affected than other parts of the country and claimed standards of care at practices remained high, with 88% of respondents to the latest GP satisfaction survey rating their experience as good or better.
A spokesman said they were working with NHS England, the Suffolk GP Federation and Health England to recruit and retain healthcare professionals, while supporting different models of care and collaboration between GP practices.
Andy Evans, chief executive of the Great Yarmouth and Waveney CCG, said the group had made “some good progress” addressing recruitment challenges. He said the development of a primary care improvement plan offered new ways to deal with the demands by increasing the support that nurses, out of hospital teams and pharmacists provide practices.
Sam Hepplewhite, chief officer at the North East Essex CCG said there was a “significant shortage” of GPs, particularly in some coastal practices, which made it difficult for patients to access a GP.
She said the CCG had been working with other health authorities to develop a plan to meet these challenges and
highlighted the launch of a “workforce development centre” in October, which co-ordinates training to help doctors “develop their career at the highest level”.
Unregistered patients more than double at Colchester hospital
The number of patients visiting Colchester Hospital who were not registered with a GP more than doubled over a two year period, raising questions about access to health services.
Responding to a Freedom of Information request, Colchester University NHS Trust confirmed 257 patients who were not registered with a GP visited in 2012 rising to 677 in 2014 – an increase of 163%.
Nationally, the growing numbers of unregistered patients has been linked with GP shortages, prompting calls for greater investment.
However Andrew Sarek, practice manager at Clacton’s Ranworth Surgery, which has stopped taking on new patients because of a shortage of doctors, warned against drawing such conclusions.
“Any patient, even in Clacton, can be registered if they need to be,” he said. “If they cannot find one, NHS England will allocate them one.”
Dr Sarek suggested the increase in hospital patients unregistered with a GP may be due to young people, who are traditionally less likely to register, or people from abroad who may not know how the health system works.
A spokesman for the hospital trust said the impact of unregistered patients was “minimal”.