In London, from Lewisham to Chase Farm, we are all too familiar with battles to save local hospitals and A&Es. But there is an even more serious crisis quietly brewing. It threatens the future of our health service across the capital, but especially in inner London. It is the dire state of our GP services, which after all account for more than 90% of the care the NHS provides....
Last month, three of my local GP surgeries announced they were going to close. I called for a crisis meeting with Jeremy Hunt, as this is happening far too often across London, where a large and growing number of practices are on the point of financial collapse.
For many years, practices in deprived areas like Islington, Hackney and Tower Hamlets were provided with supplementary funding through the Minimum Practice Income Guarantee (MPIG), in recognition of the additional health complications which often accompany deprivation. It’s been shown, for example, that a 52 year old in Tower Hamlets has the same health profile as a 70 year old in Richmond. Clearly when it comes to funding, a one-size-fits-all approach is not the answer.
There are good reasons for the fact that deprivation has historically been a major factor in determining funding levels for primary care practices. But last year when the Tories began to phase out surgeries’ MPIG funding, leaving no safety net in its place, chaos ensued. As budgets spread more thinly, GPs and staff were forced to work much longer hours, under more stressful conditions and for less pay. Many practices are only just on the right side of viable, to the extent that a seemingly small change, such as taking too long to hire a new administrator, could result in closure.
When the government began to withdraw MPIG funding last year, the Royal College of GPs warned that up to 100 surgeries – serving as many as 700,000 patients – could be forced to close as a result. We don’t yet know many have been forced to close since that time, I have put down a written question to the Secretary of State, asking him for this information, and I await the answer.
During last week’s talks, in addition to getting the Secretary of State’s agreement to shadow an inner London GP for a day so that he could begin to understand the problem, we sought guarantees that the revised funding formula would be weighted towards more deprived areas, and that the government commit to providing an emergency fund in the interim period, to protect the worst hit surgeries from forced closure. Such an emergency fund has been called for by the Royal College of GPs and is supported by more than 70% of the public.
His speech on Friday, outlining a “new deal” for general practice, did include an announcement of a £10 million fund to support “struggling” practices. While this appeared a welcome turn of events, the details are highly sketchy. It is unclear, for example, whether the money represents a new investment or whether existing funds will have to be diverted from elsewhere. We don’t yet know how the practices which benefit from this new funding – if it is new funding – will be identified, nor do we know whether the money will come with strings attached, for example a requirement that practices demonstrate progress towards the Secretary of State’s goal of extending services to seven days a week. I have put these questions to him, and I hope his answers will provide the clarity that struggling practices need.
An emergency bailout is badly needed, but it’s also a sticking plaster which won’t get at the root of the problems facing general practice. On top of the alarming increase in resignations and early retirements among the workforce, it has become harder to persuade medical students to pursue a career in general practice in the first place. And recruiting new GPs is especially tough in many parts of inner London, where the salaries are lower, the hours are longer and more stressful, and the cost of running a practice is much higher than anywhere else in the country.
Of course one way to measure the extent of the crisis in primary care is by looking at its knock-on effects on emergency care. It’s inevitable that as more and more people have to wait longer and longer to get an appointment with their GP, or can’t even register with one, they turn to hospital A&Es. As well as a much heavier financial burden, this further compounds the existing difficulties of emergency care departments, leading to longer waiting times across the board.
At the Whittington Hospital in Islington, for example, more than 18,000 people have had to wait for more than four hours to be seen at A&E since David Cameron became Prime Minister. A great many of these thousands of patients probably could have got the care they needed from a GP. And the fact is they would have if primary care in inner London was fit for purpose.
It’s all very well for Jeremy Hunt to announce his “new deal” for doctors, but whilst it was heavy on the hyperbole, it was pretty light on solutions for those London GPs hanging by their fingernails, and doesn’t offer solutions to the problems we face.