More reasons why Dutch GPs are happier

Some additional factors may contribute to British GPs being less happy than their Dutch counterparts (Feature 9 January).1

British patients are more likely to experience social deprivation and sedentary lifestyles, predisposing them to increased rates of obesity, diabetes, and alcohol or substance misuse.2 The legacy of poor occupational health and safety standards, in what was a heavily industrialised society, and high smoking prevalence, results in higher mortality from respiratory disease. Britain also has higher infant mortality and lower breastfeeding rates than the Netherlands, implying that the problems start earlier in life. Furthermore, there is a greater economic divide between rich and poor in the UK,3 perhaps explaining the higher prevalence of anxiety and depression, common causes of referral to the GP.

Britain has a lower GDP per capita than the Netherlands,4 which spends a greater proportion of this on healthcare.5 British GPs therefore have to manage a greater and more complex workload with fewer resources. In addition, although British GPs earn slightly more, housing costs and house price to income ratios are higher and rising in Britain while lower and falling in the Netherlands.6

This suggests that British GPs are struggling to meet the needs of an economically divided and unhealthy population which experiences low incomes, high housing costs, and a diminishing benefits system. Many of these patients’ GPs also struggle to live within their means, particularly if they have invested heavily in practice premises, often facing volatile or falling incomes and rising property prices. The proportion of total NHS expenditure allocated to GPs’ incomes is falling, while that for hospital consultants is rising, even though the challenges GPs face are no less difficult and their consultation rates are rising much faster than their per capita full time equivalent GP numbers.7