General practice is the core of the National Health Service and holds it together. As much as 90 per cent of all the consultations in the NHS are through GPs – our family doctors that we know and trust. Yet in London we are seeing cracks and fractures, which, if left unattended, could have disastrous results for patients and doctors.
In recent years, the number of consultations a GP performs has doubled but the number of GPs has not. This is completely unsustainable. To meet the needs of a rapidly growing population, London needs to attract more doctors to the specialty of general practice and retain the GPs it already has.
In England, 40 per cent of GPs are over 50 and in London almost 16 per cent of GPs are over 60 years old. With increasing demand on general practice, many GPs are planning and taking early retirement. The smaller practices will be forced to close. Without GPs replacing those retiring, the patient lists will be dispersed, putting even more pressure on practices that are already stretched.
The London assembly health committee, which I chair, this week set out four key recommendations that would help to ease the crisis:
- We must re-examine how we recruit and retain GPs making general practice more attractive to new entrants so that they feel emotionally rewarded for their work.
- We have called for the NHS and GPs to embrace technology. By innovating and evolving, new technology will save time and money. Most importantly, it will also be effective in improving patient care. Progressive GP practices are embracing technology and new ways of locality-based working to improve patient access. However, more needs to be done and more can be done.
- A whole care system review including looking at integrating social and health services. We need to move towards more holistic patient care, seeing the patient as a whole and social person and not simply as an isolated case number.
- Alongside all this we need investment to develop the existing primary care workforce, GP premises and invest in new state of the art facilities. The days of your local GP being able to provide services from the end of terrace house are over. Better physical facilities and better-networked facilities will provide convenience to suit the needs of patients’ family or working lives.
In addition I would go a step further and bring London GPs under a salaried scheme and look to devolving health and social care in London to a strategic body. This would allow health provision to be planned and workloads distributed more equitably across the city.
London has a unique health reality and needs its own health solutions to its growing public health problems. It is a growing city with a population of nearly nine million and incredible diversity. These health challenges require a coordinated strategic approach, not necessarily the one-size-fits-all approach offered by Whitehall.
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Dr Onkar Sahota is a London assembly member for Ealing and Hillingdon and practises as a GP in west London. He tweets @DrOnkarSahota
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