Intended for healthcare professionals

Views And Reviews Acute Perspective

David Oliver: Facts the Daily Mail omits in its GP bashing

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1091 (Published 04 May 2022) Cite this as: BMJ 2022;377:o1091
  1. David Oliver, consultant in geriatrics and acute general medicine
  1. Berkshire
  1. davidoliver372{at}googlemail.com
    Follow David on Twitter @mancunianmedic

The newspapers owned by DMG Media (including the Daily Mail and the Mail on Sunday) have been publishing incendiary articles about GPs for many years. The covid pandemic and the resulting extra strain on services have acted as an accelerant, with headlines badging themselves as crusaders for patients.

Last week an article appeared with the headline, “Now GPs want to work even less! Doctors table urgent motion in a bid to cut core opening hours to 9-5—shaving two and a half hours off.”1 The nub of the story is that the local medical committee (LMC) in Avon tabled a motion for the national LMC conference, calling for the core contracted hours of 8 am to 6 30 pm to be cut to 9 am to 5 pm. Meanwhile, the Cambridgeshire and Cleveland LMCs are submitting motions on safe workload limits for GPs.

I don’t doubt for a second that many patients are currently having serious problems with access to NHS services, including GP appointments. This was reflected in the latest NHS satisfaction survey.2 But the story in the Mail left out some important facts and context.

The UK has among the fewest doctors and nurses per 1000 people among the Organisation for Economic Cooperation and Development countries or the EU.3 Numbers of full time equivalent qualified GPs haven’t increased since 2015 and more recently have fallen.4 GPs are leaving the profession faster than people are entering GP training, and fewer international medical graduates now come to the UK or stay here.5 Yet annual recorded GP and practice nurse consultations have increased by 16% in that same period, now hitting record highs.6

A BMJ paper in 2019 showed that UK GPs saw far more patients daily than their counterparts in 10 other high income nations. Most patients are satisfied with online or telephone consulting, with only a minority preferring face to face (currently around 60% of consultations).7

General practices receive an average of £155 a year for each registered patient,8 for unlimited primary care: GP partners must cover indemnity, employee costs, building maintenance, and much more. See how far £155 gets you in private healthcare by comparison. The median number of patients on each GP’s list is over 2000, a rise of around 200 in the past decade.9

We’ve seen cuts to social care, local government, and community nursing; growing pressures on ambulances and emergency departments; and scarce acute beds, compounded by record numbers of people on waiting lists for planned secondary care. As a result, GPs can find themselves holding additional risk or providing unfunded follow-up and monitoring.10

The Mail article used a graph showing that “average GP working hours per week” were 38.5, compared with 42 in 2008. This would still be “full time” in many jobs. And the figure is based on contracted hours. GPs report working well beyond those official hours in surveys the Mail acknowledged but glossed over: it cited low numbers of Saturday appointments compared with weekdays but didn’t mention the far lower demand for those slots when they’ve been opened up.11 And many GPs do combine clinical sessions with other work in education, training, medical management, or other activities—partly because of the relentless nature of seeing too many patients in too little time but also because such activities are important to the NHS.

It might make for tubthumping headlines, but forcing GPs into longer hours, with more clinical days, more contact time, and lower pay, won’t solve the workforce crisis or improve access for patients, which the Mail claims as its mission.

Footnotes

  • Competing interests: See bmj.com/about-bmj/freelance-contributors. David Oliver is an unpaid trustee of the Nuffield Trust, an unpaid visiting professor at City University, London, and an unpaid visiting fellow at the King’s Fund. He writes both as a professional freelancer and unpaid for several publications but has never been told what he should or should not write about. He has never taken fees from pharmaceutical companies or consultancies and has never practised private medicine.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References