We GPs have been saying for some time that we are working at full capacity. There are a number of reasons for that. Firstly, the population in Lothian is growing, and bearing in mind people will attend the surgery on average five times a year, for every 100 extra patients that’s another 500 consultations per year. Not to mention the administrative burden this brings . . . the workload for GPs and their team increases massively with just a small increase in patient numbers.
People are also living longer and current policy aims to look after them in the community, at home, rather than in hospitals. As people live longer, they develop more conditions and illnesses and it becomes more complicated to look after them, so even the same number of patients creates a lot more work.
Providing sufficient premises for GPs is an issue we have been seeing for some time now in Lothian and we’re getting to the point where there are certain parts of Edinburgh, particularly, where it may become really difficult for someone to register with a practice. We need increasing space to cope with the additional demands.
Historically, Lothian did invest in premises for primary care, but more recently the focus has been primarily on hospitals. We have some excellent hospital buildings and we have two more planned in the near future that are multi-million pound investments. By comparison, the investment in primary care premises has been relatively trivial.
To be fair to NHS Lothian, there is a strategy going through the consultation process at this very moment to look at the premises and invest in them. I think they at long last realise that we need to invest now and cannot wait.
There are a number of practices, including here at Restalrig Park, that for a relatively small investment could increase capacity and allow their list size to grow. We just can’t at the moment, we’re completely full, and the population in Leith is growing dramatically. Most of us are in premises that need expansion or refurbishment to allow us to cope. The good news is that with relatively small sums of money we could sort this out. It is a drop in the ocean of the NHS budget. Longer term we will need more practices.
Premises are vital but as well as that we need more GPs, more nurses and more staff – it’s no good simply having lots of rooms.
The problem with GP numbers is actually a government issue. When a partnership takes on a new GP, there is a significant financial hit until the list size grows which takes two or three years.
A practice is a small business and needs to remain financially viable. It used to be that when a new doctor was appointed, there was a sum of money that came to the practice to tide the practice over until its list size grew. That has been done away with and must be looked at again, because at the moment there is no way a practice can take on a new partner.
Morale is extremely low among a lot of GPs because we don’t like not being able to offer appointments for our patients, or not being able to deliver the quality care we would like to because of increased demand. This is as distressing for the GPs as it is for patients.
The problem is when you’re so full and you’re so busy, you just can’t provide safe practice. It’s not in the patients’ interest to allow more and more to register with a practice. There comes a point when a practice has to say that it can’t physically cope with more patients and, it makes me uncomfortable to say it, we are very close to being at that stage in Restalrig, along with many other local practices.
Richard Williams GP is a partner at Restalrig Park Medical Centre and a member and former chairman of the Lothian Local Medical Committee