Agenda item

(To receive a report by Dr Kieran Sharrock, Medical Director of the Lincolnshire Local Medical Committee, on the shortage of GPs working to serve the population of Lincolnshire)

Prior to giving consideration to this item, the Chairman advised that two press articles had been published on this topic since the last meeting of the Committee:-

1.   "GPs to be offered £8,000 incentive to come and work at struggling practices in Lincolnshire" – this article reported that under proposals from NHS England, practices who could prove that they have had difficulties with recruitment would be able to offer up to £8,000 to prospective GPs which included estate agent fees, rental costs and the cost of boarding school fees; and

2.   "NHS to fly in GPs from across the world to combat staff shortages in Lincolnshire" – this article reported that Lincolnshire was to take part in a national pilot to recruit doctors from across the world to fill gaps in the county's health service.  This would include experts from Poland, Spain and Romania.

The Chairman also reported that the Councillor Mrs S Woolley had written to the MP for Boston and Skegness in her role as Chairman of the Lincolnshire Health and Wellbeing Board.  The MP was asked to consider the possibility to offer tax incentives to those GPs coming to Lincolnshire rather than offering more money, as suggested in recent press articles, as it was thought this method would not guarantee success.

A report by Dr Kieran Sharrock (Medical Director – Lincolnshire Local Medical Committee) was considered which provided information on the shortage of GPs working to serve the population of Lincolnshire.

Dr Kieran Sharrock (Medical Director – Lincolnshire Local Medical Committee) and Debra Burley (Chief Executive – Lincolnshire Local Medical Committee) were in attendance for this item of business.

There was an increasing crisis in General Practice nationally and this was predominant in Lincolnshire.  415 GPs were required to serve the population but only 340 were in post, leaving a shortfall of 75 GPs.  This led to a shortage of GP appointments which then put additional pressure on other healthcare providers or, in a lot of cases, patients received no care at all.

It was reported that the workload for general practice had expanded dramatically over recent years and, in ten years patients presenting at their GPs had doubled with the average patient attending the surgery eight times per year.  The increase in workload was due to:-

1.    An ageing population who had more long term conditions such as diabetes, lung disease and heart disease;

2.    Conditions which were traditionally managed in hospitals were now managed within general practice; and

3.    Patient demand for immediate access which was often inappropriate.

Practices continued to transform ways of working by forming larger groups of practices to work collaboratively.  They also employed alternative health professionals, including pharmacists, nurses, paramedics and physiotherapists, to provide care in a different way.  This could only partially replace the unique role of the GP, however.

Recruitment of GPs from other parts of the UK would help but would not help the crisis overall therefore recruitment from outside the UK was thought to be the only sustainable option.  In the long term, underfunding of the NHS and general practice needed to be reversed to ensure services were safe and sustainable. 

It was stressed that training more doctors for the future was essential to that success and that Health Education England (HEE) and the General Medical Council (GMC) be urged to increase the number of training places within medical schools to avoid similar crises happening in the future.

The Committee received a presentation which provided the following information:-

1.    What are the Shortages?;

2.    Doctors per patient – average number of patients per GP (excluding Registrars, Retainers and Locums) – Headcount;

3.    Ageing population of GPs – percentage of Practitioners (excluding Registrars, Retainers and Locums) aged 55 and over – Headcount;

4.    Alternative Health Professionals – All Nurses;

5.    Health spending – as proportion of GDP;

6.    Health spending compared to other OECD countries; and

7.    Funding for general practice – real term investment in general practice (figures based on 2014/15 prices).

It was confirmed that the figures used in Slide 3 of the presentation had been taken from the Lincolnshire Research Observatory (LRO) and did not include the figures for people living in Cambridgeshire, Peterborough, etc, who may be registered with a GP in the South Lincolnshire CCG area.

Members were given the opportunity to ask questions, during which the following points were noted:-

·       Recruitment from Europe was being actively pursued as currently approval of visas for applicants from Commonwealth countries was not guaranteed as the Home Office did not recognise GPs as being a shortage;

·       Concern was increased as a number of practices on the east coast of the county, as well as in Gainsborough and Lincoln, had indicated that their practices were not sustainable and ultimately these practices would not be able to fulfil their contracted obligations;

·       Currently a package of care for overseas doctors was being considered.  Included in that would be an English language test at the end of the training package and this would include reading, writing, comprehension and language.  Payment would not be made unless the test was passed;

·       Although Spain had a surplus of doctors, the cultural difference between the two areas was such that a great number returned to Spain after a short period of time.  As part of the Sustainability Transformation Plan (STP), work was ongoing with the Trusts to produce an Attraction Strategy which included GPs and Nurse Practitioners as well as the wider health community.  Work with the Chamber of Commerce was also underway which was looking to improve recruitment within all sectors within Greater Lincolnshire, and on the east coast in particular;

·       There were lots of avenues to encourage people in to nursing and to ensure that they were offered the right level of training.  This included Lincoln University, a talent academy set up by United Lincolnshire Hospitals NHS Trust (ULHT) and an NHS Careers College for Bands 1-7;

·       Figures used were based on LRO population for the CCGs in Lincolnshire and did not include temporary residents so the figures given would be higher;

·       The LMC were commended for proactively working on these issues to relieve the pressures faced;

·       It was suggested that the GP shortage was not a new problem and one often faced when government changed the number of places in medical schools;

·       It was noted that the vocational scheme had improved since the three year financial incentive had been given.  It was hoped that the cohort currently in that scheme would assist in filling the gap;

·       A new website was being developed in an attempt to improve the reputation outside of Lincolnshire was included a marketing campaign with a video about Lincolnshire General Practice.  GP Registrars appeared on that video which could be found at www.lincolnshiregeneralpractice.co.uk ;

·       When asked why the majority of GPs retired at the age of 55, it was explained that this was generally the age where the pension contributions would stop.  Retired GPs often chose to return to practice on a part-time basis but it had been found that this was reducing dramatically due to the workload involved;

·       GP training was different to that provided for hospital doctors and it was thought that this should be more inclusive, with previous roles being considered as part of the training before extensive, possible duplication, training was undertaken;

·       It was stressed that patients had been going to their GPs to ask them to pursue follow-up hospital appointments which was inappropriate.  The GP practices had found themselves assisting with this to the point it had become best practice although this should not be the case.

At 12.00pm, Councillor B W Keimach left the meeting and did not return.

The Chairman thanked the Lincolnshire LMC for the work undertaken to establish a better understanding in regard to the GP shortage.

RESOLVED

1.    That the report and comments be noted in relation to the crisis facing general practice;

2.    That the endeavours of GPs, practices and Clinical Commissioning Groups to make GP services sustainable be supported;

3.    That further action, for example by lobbying MPs on overall NHS funding and the decline in the proportion of funding which goes to provide GP service, be supported;

4.    That increased recruitment from countries outside the UK where there was a surplus of doctors, be supported; and

5.    That the efforts to increase medical school places in the UK and in Lincolnshire specifically, be supported.