General practice on the brink: three key solutions the government must implement.
Dear Editor
Salisbury provides an accurate description of the importance of general practice to the NHS and its current state of crisis.(1) Workload pressures, chronic staffing shortages, and, high stress levels are just some of the issues and these are all exacerbated by the historical under investment in this part of the NHS.(2-4) The country urgently needs efficient and proactive general practice services and although there are many solutions to this crisis, we believe there are three that the government should urgently implement.
Working in general practice can be very rewarding but it can also be very much harder than it should be. There is a growing body of research and plenty of anecdotal evidence that many GPs are experiencing high stress levels, and this is contributing to low morale, poor mental well-being, exhaustion, and burnout.(3-6) This is harmful for doctors’ lives and can also affect the quality of care for patients.(7,8)
It is now time to prioritise the health of doctors. Our aim should be to create workplaces that support doctors and other healthcare staff by promoting their health and wellbeing.(3,9) The health promoting general practice would enable doctors to survive and thrive, and would be good for staff retention, quality of care, and patient health and satisfaction.(10)
Public health specialists from local authorities could initiate and support health promoting general practices. Their core skills of needs assessment, program planning, and systems thinking, are ideal for this type of activity. However, public health departments are also underfunded and would need increased resources for them to undertake this type of activity.(11)
The second solution that we propose is that the government should put a greater emphasis on promoting population health and reducing inequalities.(11,12) Key public health priorities including obesity, mental health, alcohol misuse, lack of exercise and accident prevention require a multi-sector approach and it shouldn’t just be left to general practice to pick up the pieces. The new Office for Health Promotion should set as one of its earliest tasks the development of a long-term positive multi-sector health promotion strategy. Schools, workplaces, voluntary organisations and local communities can all have significant roles to play.
The third solution is one that is fundamental to success. The government needs to address the long-standing underinvestment in the NHS and particularly in general practice.(2-4,9,13-16) With increased and sustainable funding in general practice, doctors, nurses and allied health staff would be more likely to meet the current and future challenges including an aging population, multimorbidity and the backlog of care caused by the covid pandemic. An immediate injection of funds would enable significant issues such as premises, IT infrastructure and administrative support to be addressed. Moreover, it would also send a clear signal that general practice is valued and this will assist with recruitment and retention of hardworking but overloaded doctors and nurses.
General practice is the cornerstone of the NHS but drastic and immediate action is needed. We recommend three initial solutions: creating health promoting general practices; putting a greater emphasis on promoting population health; and, immediately addressing the underinvestment issue. These we believe will be good for the health of doctors and nurses, good for patient health, and for the survival of the NHS.
5) Hanson P, Clarke A, Villarreal M, Khan M, Dale J. Burnout, resilience, and perception of mindfulness programmes among GP trainees: a mixed-methods study. BJGP Open 2020; 4 (3). https://bjgpopen.org/content/4/3/bjgpopen20X101058
8) Hall L, Johnson J, Watt I and O’Connor D. Association of GP wellbeing and burnout with patient safety in UK primary care: a cross-sectional survey. Br J Gen Pract 2019, 69 (684): e507-e514. https://bjgp.org/content/69/684/e507
12) Watson M C, Owen P. Inequalities in 2020: time for a health strategy that unites the country BMJ 2020; 368 :m544 doi:10.1136/bmj.m544 https://www.bmj.com/content/368/bmj.m544
16) Iacobucci G. Covid-19: Government must invest in primary care to aid pandemic recovery, say leaders. BMJ 2021;373:n1208 https://www.bmj.com/content/373/bmj.n1208
Competing interests:
No competing interests
18 May 2021
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Professor Patricia Owen, President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, PO Box 7409, Lichfield WS14 4LS, UK. http://ihpe.org.uk/
Rapid Response:
General practice on the brink: three key solutions the government must implement.
Dear Editor
Salisbury provides an accurate description of the importance of general practice to the NHS and its current state of crisis.(1) Workload pressures, chronic staffing shortages, and, high stress levels are just some of the issues and these are all exacerbated by the historical under investment in this part of the NHS.(2-4) The country urgently needs efficient and proactive general practice services and although there are many solutions to this crisis, we believe there are three that the government should urgently implement.
Working in general practice can be very rewarding but it can also be very much harder than it should be. There is a growing body of research and plenty of anecdotal evidence that many GPs are experiencing high stress levels, and this is contributing to low morale, poor mental well-being, exhaustion, and burnout.(3-6) This is harmful for doctors’ lives and can also affect the quality of care for patients.(7,8)
It is now time to prioritise the health of doctors. Our aim should be to create workplaces that support doctors and other healthcare staff by promoting their health and wellbeing.(3,9) The health promoting general practice would enable doctors to survive and thrive, and would be good for staff retention, quality of care, and patient health and satisfaction.(10)
Public health specialists from local authorities could initiate and support health promoting general practices. Their core skills of needs assessment, program planning, and systems thinking, are ideal for this type of activity. However, public health departments are also underfunded and would need increased resources for them to undertake this type of activity.(11)
The second solution that we propose is that the government should put a greater emphasis on promoting population health and reducing inequalities.(11,12) Key public health priorities including obesity, mental health, alcohol misuse, lack of exercise and accident prevention require a multi-sector approach and it shouldn’t just be left to general practice to pick up the pieces. The new Office for Health Promotion should set as one of its earliest tasks the development of a long-term positive multi-sector health promotion strategy. Schools, workplaces, voluntary organisations and local communities can all have significant roles to play.
The third solution is one that is fundamental to success. The government needs to address the long-standing underinvestment in the NHS and particularly in general practice.(2-4,9,13-16) With increased and sustainable funding in general practice, doctors, nurses and allied health staff would be more likely to meet the current and future challenges including an aging population, multimorbidity and the backlog of care caused by the covid pandemic. An immediate injection of funds would enable significant issues such as premises, IT infrastructure and administrative support to be addressed. Moreover, it would also send a clear signal that general practice is valued and this will assist with recruitment and retention of hardworking but overloaded doctors and nurses.
General practice is the cornerstone of the NHS but drastic and immediate action is needed. We recommend three initial solutions: creating health promoting general practices; putting a greater emphasis on promoting population health; and, immediately addressing the underinvestment issue. These we believe will be good for the health of doctors and nurses, good for patient health, and for the survival of the NHS.
References
1) Salisbury H. Helen Salisbury: General practice on the brink. BMJ 2021;373:n1187
https://www.bmj.com/content/373/bmj.n1187
2) BMA. Saving general practice. London: BMA, 2017.
https://www.bma.org.uk/media/2844/bma-saving-general-practice-report-nov...
3) General Medical Council. Caring for doctors. Caring for patients. London: General Medical Council, 2019.
https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-p...
4) Health Foundation Feeling the strain. What the Commonwealth Fund’s 2019 international survey of general practitioners means for the UK. London: Health Foundation, 2020.
https://www.health.org.uk/publications/reports/feeling-the-strain
5) Hanson P, Clarke A, Villarreal M, Khan M, Dale J. Burnout, resilience, and perception of mindfulness programmes among GP trainees: a mixed-methods study. BJGP Open 2020; 4 (3).
https://bjgpopen.org/content/4/3/bjgpopen20X101058
6) Iacobucci G. GPs are at “breaking point” and in need of respite, leaders warn. BMJ2021;373:n1139.
https://www.bmj.com/content/373/bmj.n1139?ijkey=d705d91dd7de82acaae0e302...
7) Hall L, Johnson J, Heyhoe J, et al. Exploring the impact of primary care physician burnout and wellbeing on patient care: a focus group study. J Patient Saf 2020 Dec;16(4):e278-e283.
https://journals.lww.com/journalpatientsafety/Abstract/2020/12000/Explor...
8) Hall L, Johnson J, Watt I and O’Connor D. Association of GP wellbeing and burnout with patient safety in UK primary care: a cross-sectional survey. Br J Gen Pract 2019, 69 (684): e507-e514.
https://bjgp.org/content/69/684/e507
9) Watson M and Lloyd J. Time to put GPs first by investing in general practice. BMJ 2019;365:l4158
https://www.bmj.com/content/365/bmj.l4158
10) Watson, M. Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.
https://primarycare.imedpub.com/going-for-gold-the-health-promoting-gene...
11) Watson M C and Thompson S. Government must get serious about prevention. BMJ 2018;360:k1279.
https://www.bmj.com/content/360/bmj.k1279
12) Watson M C, Owen P. Inequalities in 2020: time for a health strategy that unites the country BMJ 2020; 368 :m544 doi:10.1136/bmj.m544
https://www.bmj.com/content/368/bmj.m544
13) House of Commons Health Committee. Primary care. Fourth Report of Session 2015–16. HC 408. London: HOC, 2016
https://publications.parliament.uk/pa/cm201516/cmselect/cmhealth/408/408...
14) NHSE. The NHS Long Term Plan. London: NHSE, 2019.
https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term...
15) NHS Confederation. Restoring primary care. London: NHS Confederation, 2021.
https://www.nhsconfed.org/-/media/Confederation/Files/Publications/Docum...
16) Iacobucci G. Covid-19: Government must invest in primary care to aid pandemic recovery, say leaders. BMJ 2021;373:n1208
https://www.bmj.com/content/373/bmj.n1208
Competing interests: No competing interests