NHS gaining managers but losing GPs
Recently , the Guardian published an article detailing how the NHS has gained around 4,000 managers in the last four years , ever since the government introduced a ‘ bureaucracy-busting ’ shakeup of the health service . This equates to an almost 18 % increase in managers , according to official statistics .
In 2013 , the Health and Social Care Act came into force , with a view to combatting the rising demand and treatment costs , the need for improvement and the state of the public finances . The main aims of the act were :
• To put clinicians in charge of shaping services , enabling NHS funding to be spent more effectively .
• To provide regulation to support innovative services
• To provide a greater voice for patients
• To provide a new focus for public health
• To provide greater accountability locally and nationally
• To provide streamlined arms-length bodies , by removing unnecessary tiers of management , releasing resources to the frontline .
Given the above , the latest data would appear to be at odds with the aim of the Act to reduce management positions . According to the Guardian , there has been a rise of about 4,650 in total management posts since April 2013 , and NHS Digital figures show management posts have risen from 26,051 in April 2013 to 30,724 at the end of 2016 .
The BMA ( British Medical Association ) has been critical of the latest statistics , and stated that it would be distressing for patients to learn that management posts were rising as GP numbers continued to fall .
According to the Guardian , Dr Richard Vautrey , deputy chair of the BMA ’ s GP committee , was outspoken with his comments on the matter , suggesting that NHS policy is failing to match government rhetoric .
“ Patients will be bemused that when their care is being undermined by GP and nurse staff shortages , the number of administrative posts has risen again . With the NHS at breaking point , we need ministers to get their priorities right .
They need to follow through on their election pledges and invest in recruiting more GPs so that we can offer enough appointments to the public .”
With long patient waiting lists , increasing GP patient registrations , huge pressure on referral turnarounds , a shortage of hospital beds and numerous operations being cancelled and delayed every day , it may well be argued that increasing the numbers of managers should not be a priority for the NHS . With this in mind , surely the increase in trained doctors and nurses is paramount , and the increase in managers seems unnecessary and a waste of precious NHS funds .
The current Health Secretary Jeremy Hunt announced plans in 2014 to ‘ train and retain ’ 5,000 more GPs by 2020 . This has since been re-clarified to include doctors in training . However , according to the latest NHS England figures , 92 practices closed in 2016 . This was an increase of 114 % on GP surgery closures in 2014 . While 34 merged with other practices , the remainder shut completely .
Practice Business reported this week that almost half of GP surgeries close at some point during working hours . This follows on from an article in the Telegraph in February this year that reported that half of GP surgeries open for under 8 hours a day , with more than 1,500 opening for under five hours daily .
This has been highly criticized , and according to the Telegraph , Theresa May has warned that GPs will lose access to extra funds intended for weekend and evening opening if they continue to regularly close for half days during the week . But the BMA argues that GP practices did not have enough funds or staff to stay open longer hours . Dr Richard Vautrey , said : “ The vast majority of practices are struggling to deliver even basic care in weekday hours and do not have the staff or resources to deliver anymore services … What these figures don ’ t show is how much better the short term investment could have been used to deal with the day-to-day workload pressures facing GP practices and out of hours organisations ”.
However , speaking to the Telegraph , Professor Helen Stokes-Lampard , chairman of the Royal College of GPs , said : “ These figures don ’ t give the full story of what ’ s happening in general practice – they only take into account surgery time , not practice opening hours .
“ Obviously , a large part of a GP ’ s work is seeing patients in face to face consultations , but there is a lot more involved in day to day general practice – and just because actual surgeries aren ’ t taking place , it doesn ’ t mean patient care isn ’ t being delivered via telephone or online consultations , or by making home visits .
“ There are also vital administrative duties , such as hospital referrals , prescriptions and test analysis that need to be dealt with during the working day , which is growing ever longer for GPs and our teams due to the intense pressures we face as we try to cope with increasing patient demand and complexity .”
A report by the Public Accounts Committee stated that there had been ‘ no progress ’ in the last year on increasing the number of GPs , despite the government target to recruit 5,000 more by 2020 , as stated above . The number has actually fallen in the last year , from 34,592 full-time equivalent doctors in September 2015 to 34,495 in September 2016 . The report stated that more trainees needed to be recruited , while existing GPs should be encouraged to stay on .
It is also feared that the number of trained doctors and nurses will take a nosedive as the UK prepares to leave the EU . A total of 2,348 doctors from the other 27 EU states left NHS England between July and September 2016 compared with 1,281 in the same period in 2015 . This was an increase of 83 %.
With the increasing pressures on the NHS , and with the general election , and Brexit just around the corner , only time will tell what effect these changes will have on the NHS . But one thing is for sure ; if the numbers of doctors in the NHS keep decreasing , sadly the NHS simply will not get better .
By Hannah Baty
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