The recruitment and retention crisis in General Practice is something we are all familiar with, a topic on the agenda for the past decade at least. However, it is really starting to bite with multiple practices reporting vacancies and little to no interest from the workforce in filling them.
Over the same decade we have been promised an additional 800 GPs, with this target banded about by Scottish Government but (in some places in the NHS recovery plan) apparently pushed back to 2028 for being met – and with limited evidence that anywhere near sufficient progress is being made.
Last week, I took part in a panel discussion on Recruitment, Retention and Wellbeing in Primary Care at the Holyrood Heath and Care Festival in Edinburgh. The first question I was asked was whether the Scottish Government’s Workforce Plan is adequate to address the pressures in our system: it was the easiest answer of the day, no.
No, it will not help address the fact over a third of GPs are over 50, many facing unfair pension charges; no, it does not address why we lose so many newly qualified doctors who feel it is too difficult to create a satisfying work/life balance in the current environment; and no, it does nothing to address the huge demographic challenge we face in the 2030s with exponential growth in the elderly population, coupled by less staff and less tax to resource all health and social care services.
The question is then, what can be done? We must focus efforts on maximal retention of all staff at the same time as promoting General Practice as a fulfilling and enjoyable career. Urgent pension reform, wellbeing and psychological support and better mentorship for newly qualified GPs would offer instant improvement and help to make general practice a more attractive option for medical graduates.
We need more headspace to improve the efficiency of services, especially with the integration of new allied health professionals into our practices’ ways of working. Protected learning time must return to give Practices that dedicated space for continuously learning, development and access to the most relevant and current ways of working. We must promote the joy in our work, collaboration with colleagues and have time to see patients who are better from our interventions (not just those that have unresolved issues).
The public has to play its part too. We must see efforts to improve health literacy in the population, promote physical wellbeing and encourage self-care as well as there being better sign posting to services. Not enough has been done in any of these areas, with the likelihood being that the practices serving areas of poor health literacy to be the ones with the most severe capacity problems.
And lastly, we must be kind to ourselves and proud of what we do. Being a GP is one of the most difficult jobs to do well but also the most rewarding. We have the privilege of being able to make a real difference to the lives of our patients, caring for them from the cradle to the grave. It is a career worth fighting for, “the bedrock of the NHS”, and the only way a free at point of service healthcare system is possible.
Iain Morrison is a GP partner in Midlothian and a member of BMA Scotland’s GP committee.