The ideal of the family doctor is fixed in our minds by folklore, be it Dr Kenneth in Wuthering Heights or Dr Cameron and Doctor Finlay in Doctor Finlay’s Casebook.
However it may have changed, and now more commonly referred to as general practitioners (GPs), the institution remains One of the great strengths of the NHS. Overwhelmingly they remain private contractors who provide their services to the NHS. Strangely enough, when the wartime coalition government was making plans to set up the NHS, it envisaged nationalising the GPs (by making them paid NHS employees rather than private contractors) and leaving hospitals as the independent bodies that they then were. When the post war legislation was introduced however, they did it the other way round, by nationalising the hospitals and leaving GPs as private contractors.
When people write to me demanding an end to all privitisation in the NHS and requiring all services to be exclusively provided by the state, I reply by asking if they really want their GP to be nationalised?
The GP is the gate-keeper to other NHS services. Before your GP even begins an examination of the ailment that has brought you to the surgery, she -or he- starts will all sorts of knowledge about you, your family, and your medical history. So, she is ideally placed to decide how serious your condition is and whether you need to be referred to a specialist.
The problem is that this strength has been eroded over the last few decades as more of the NHS resources have been invested in hospitals at the expense of general practice. Too many GPs are leaving the profession at a time when rising patient numbers, and the complex needs of an aging population, mean that the demands for their services are growing exponentially. There is however, a plan to address the problem:
- More funding –an extra £2.4 billion annually for general practice to increase to over £12 billion a year by 2020/21 (a 14% increase in real terms). Last year the first £507 million of this growth was delivered.
- Providing a new affordable professional indemnity system for GPs and their staff against clinical negligence risks
- Increasing recruitment – record numbers of medical graduates are choosing general practice and the supply of medical students is being increased by a record 25% – 1,500 more medical school places every year, focussed on producing family doctors.
Last month, the Care Quality Commission gave a positive verdict on the state of General Practice in England: Nearly 90% of practices received ‘good’ or ‘outstanding’ ratings, whilst of the rest with lower ratings, the overwhelming majority of them are improving.
There is however, something more that needs to be done. Only a quarter of GPs have had any formal training in mental health, of those that have, it has been in psychiatry of an advanced sort that is well beyond the more commonplace conditions that are now presenting in terms of anxiety and depression. Addressing this omission, I believe, should be a matter of urgency.