Intended for healthcare professionals


Tackling the crisis in general practice

BMJ 2016; 352 doi: (Published 17 February 2016) Cite this as: BMJ 2016;352:i942
  1. Martin Roland, professor of health services research1,
  2. Sam Everington, chair2
  1. 1Cambridge Centre for Health Services Research, University of Cambridge, Cambridge CB2 0SR, UK
  2. 2Tower Hamlets Clinical Commissioning Group, Mile End Hospital, London E1 4DG, UK
  1. Corresponding author: M Roland mr108{at}

If general practice fails, the whole NHS fails

Hospitals’ financial problems always make headlines, and The BMJ’s recent editorial by Chris Ham, chief executive of the think tank the King’s Fund, emphasised the crisis that hospitals in England are facing.1 A £2bn (€2.6bn; $2.9bn) funding deficit certainly sounds dramatic, but hospitals don’t go bust: someone usually picks up the bill. General practice doesn’t have that luxury, and its share of the NHS budget has fallen progressively in the past decade, from a high of 11% in 2006 to under 8.5% now. Many practices will see further reductions over the next three years.

On performance, hospitals again grab the headlines. But stories about breaches of waiting time targets in emergency departments rarely consider why more and more patients go to hospital—namely, the strain on general practice. Recent research shows levels of stress among general practitioners that are unprecedented since surveys began in 1998,2 with increasing workload and overwhelming regulatory burdens. GPs now do an estimated 370 million consultations each year, 60 million more than five years ago.3 Seeing 60 patients a day is not uncommon.

A recent international survey by the US Commonwealth Fund found that only 22% of UK GPs reported that the NHS was working well, a dramatic drop from 46% in 2012, and that they experienced higher levels of stress than primary care doctors in any of the other countries surveyed.4 Comments by GPs at a recent national conference encapsulate the sense of despair: “The pressure of work leaves me in constant fear …

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