Shortage of family doctors leaves health care in crisis

The NHS is facing a chronic shortage of family doctors after official figures showed some GPs were responsible for 9,000 patients.

By Rowena Mason, Political Correspondent
10:00PM GMT 26 Dec 2011

More than a million people were registered with a GP who served more than 3,000 patients, almost twice the average list size of 1,600.

Experts warned that doctors with vast numbers of patients might not be providing the best service, with their practices seeing poorer care and longer waiting times.

The figures show the worst surgeries for securing a doctor’s appointment within two days have 50 per cent more patients per GP than the average practice.

Leading doctors warned that the problem was likely to be exacerbated by reforms planned by Andrew Lansley, the Health Secretary.

Dr Michael Dixon, chairman of the NHS Alliance, which represents the UK’s primary care trusts, said it was a question of whether doctors were “able to cater as well for each patient with a list once they get much over 2,000 or 3,000”.

He said shortages were already being seen in inner cities, but recruiting GPs had become a problem even in affluent rural areas such as his practice in Devon.

“We’re not producing enough GPs as opposed to specialists,” he said. “Our workforce is in the wrong place. It’s in hospital whereas it needs to be in the community. This is already beginning to show and it will get worse over the next year or so.”

England has 25,000 family doctors, but there are growing concerns that the NHS faces a retirement crisis. According to a survey by the British Medical Association published in June, one in eight GPs is planning to retire within two years.

A third of that group raised concerns about NHS reforms while pay freezes, pension changes and increasing workloads were also significant factors.

The shortages have been exacerbated by the retirement of a generation of Asian GPs who came to Britain during the 1960s and 1970s.

The search for replacements is hindered by restrictions under which the NHS is only allowed to employ foreign doctors if there are no suitable staff in Britain or the European Union.

Prof Aneez Esmail, from Manchester University, said: “There was an influx of Asian doctors in the 1960s and 1970s. Many of these went to work in under-doctored areas in inner cities and my research shows they were retiring in the 2000s.

“There was also a clampdown on recruitment of doctors from the subcontinent around 2009. We thought we had enough British graduates but most were going into hospital medicine.”

There are also concerns that the growing number of female GPs, many of whom work part-time because of family commitments, will lead to further shortfalls.

Two thirds of trainee GPs are women and research by the Royal College of Physicians has found that women GPs will outnumber their male colleagues by 2013.

Dr Sarah Wollaston, a Tory MP and former family doctor, said: “It creates all sorts of pressures as women take time out with family commitments. There is a real risk of a shortage.”

The Centre for Workforce Intelligence has recommended that an extra 450 GP training posts should be filled each year over the next four years. However, the number of doctors training as GPs fell by 7 per cent this year, even though more places have been made available.

Dr Wollaston added that many medical students perceive hospital careers to be more glamorous. She has written to Mr Lansley warning him there are “real problems brewing” around the number of GPs.

“I do not think if you have 6,000 people on your list you can possibly be delivering the best service,” she added. “It’s just not possible.”

Doctors in the South East are having to deal with the greatest number of patients, with average list sizes of more than 2,000 in primary care trusts such as Westminster, Brighton, Essex and Hounslow, west London. In comparison, GPs working in Devon, Bristol and Somerset have only around 1,300 patients on average. Overall, one in five GPs has a list of more than 2,000 patients.

According to the Department of Health data, two GPs — one in Camden, north London and one in Newham, east London — have 9,000 patients each.

The shortage of GPs in some areas means some family doctors have to work harder than ever. Dr John Harban, a family doctor in Barnsley, South Yorkshire said he coped with a list of more than 6,000 patients by offering a walk-in system where no appointment was necessary and by working from 8am to 8pm.

“It means they might have to wait a bit longer but they will always get seen,” Dr Harban added.

A spokesman for the Department of Health said there was “no evidence of difficulties accessing GPs”.

However, she said the department planned to make training more flexible to ensure the right people became GPs.

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