Britain’s GP provision in crisis due to COVID-19 pandemic and years of cuts

While governments and media outlets the world over have proclaimed the end of the COVID-19 pandemic, the reality is starkly different. The pandemic is continuing to wreak havoc on health services across the UK, as the decades-long cutbacks that have crippled the National Health Service (NHS) bite ever deeper.

The impact of COVID, the vaccine rollout and backlogs across the system are resulting in increased demand on a National Health Service already barely able to cope. The crisis in primary care services, in which General Practitioners (GPs) play a vital role, is having a crippling effect. Last month the Guardian quoted Prof Martin Marshall, Chair of the Royal College of General Practitioners (RCGP) who said, “The fact that general practice is under such enormous pressure means it can’t deliver the patient-centred services that it wants to. Many GPs are even finding it challenging to maintain a safe service.”

Marshall was referencing the 4.5 percent decline in GPs across England. In 2015, the Conservative government pledged an increase of 5,000 GPs by 2020. In 2019, then Health Secretary Matt Hancock admitted the target would not be reached. The latest assurance of an additional 6,000 GPs by 2025, under conditions in which the latest fall in GP numbers is 1,307, confirms this promise is worthless.

This decline continues the year-on-year decline in GP numbers since the initial pledge was made. According to a September 14 British Medical Association (BMA) report, the GP workforce “has actually shrunk by 1,904 since 2015.”

Marshall warned that “GPs are finding it increasingly hard to guarantee safe care to their patients,” noting, “The chances of making a mistake in a diagnosis or a mistake in a referral decision or a mistake in prescribing are all greater when you’re under stress. And if you’re working 11-, 12-hour days, seeing 50, 60 patients… the chances of you making a mistake, we all know, are higher.”

He made these remarks as pressure mounted over the inability of patients to access face-to-face appointments, something that NHS England instructed GPs to ensure were being offered since May of this year. Many patients preferred the move to remote consultations, not only for fear of catching COVID and passing it on, but in order to protect the NHS and ensure those requiring immediate treatment got it. But the right wing press has revelled in the failure of GPs to meet the renewed demand for face-to-face appointments.

The Daily Mail began a September 21 piece with the headline, “Your doctor won't even talk to you now.”

A causal link between the lack of face-to-face provision and some deaths has been established, as found by the senior coroner of Greater Manchester, Alison Mutch. In response, the right-wing press is doing all it can to blame GP surgeries and to conceal the difficulties faced by GPs in attempting to re-open for face-to-face appointments.

Such vitriol has opened GPs up to a vicious backlash. GPOnline reported on an attack on September 17 against a GP in Manchester, which resulted in a fractured skull for the GP and “deep lacerations” suffered by members of staff. While the specific circumstances of the attack were not detailed, recognition of “anti-GP rhetoric” and the increase in abusive and violent behaviour were considered to have an impact.

The strain is set to worsen still, with the booster jab programme of COVID vaccines, which began September 16. GPs have been responsible for issuing close to two-thirds of the 92 million vaccination jabs that have been administered across the UK. The booster programme also comes into effect during the flu jab season, which has already been hampered due to supply issues.

The British Medical Association (BMA) wrote in a September 15 article, “The number of COVID vaccinations delivered by GP practices has been falling since its peak of 8 million appointments in May, but still amounts to 2.1 million appointments. GP practices have been at the forefront of the NHS’s response to the pandemic, but COVID appointments take up practice capacity – including COVID appointments. The overall appointment count for July 2020 is nearly one million higher than pre-pandemic levels (July 2019).”

On September 20, the Local Medical Committee (LMC) of Kernow in Cornwall, England issued a statement declaring that local GPs were on the brink of crisis. The statement highlighted “outpatient capacity issues” at regional hospitals having a knock-on effect on the local surgeries who were picking up these cases. The statement stressed, “These issues are compounded by longstanding GP and practice nurse shortages after years of under-resourcing nationally.”

A BBC News article highlighted the strain on practices in parts of Wales. It noted that the Community Health Council (CHC) declared there was a “crisis of access” to GPs, with many people left waiting in excess of an hour to get through on the phone. Appointments were often fully booked for the day, even 10 minutes after lines opened at 8 a.m. Health boards said that demand was up as much as 20 percent in certain parts of the country. Geoff Ryall-Harvey, of the North Wales CHC, said, “Part of the problem goes back before the Covid pandemic. There has been a steady decline in the number of GPs working in Wales.”

These local instances are repeated across the country because of a systematic neglect of the NHS by successive governments over decades, dating back to the Thatcher Tory government, throughout the Labour years, the Conservative-Lib Dem coalition, and the most recent years of Tory social counter-revolution.

Barely a year after the initial promise for more GPs, a letter was leaked highlighting the real attitude towards GPs--the demand that they be allowed to “fail and wither.” The letter from a senior National Health Service England official exposes plans that could result in the closure of up to 800 “vulnerable” General Practices. The WSWS warned, “The central aim of the policy that GP practices ‘be allowed to fail and wither’ is nothing but creating the most favourable conditions for… private companies to profit from patient care services.”

This warning has been vindicated. As we drew attention to in May, over £100 billion worth of NHS contracts had been handed to the private sector in the previous decade. One example was the 37 GP surgeries bought out by a US insurance company.

The BMA held an emergency meeting with Health Secretary Sajid Javid over the issue of the abuse GPs are currently facing, but made only a mealy-mouthed demand for “more action to enable practices to expand their workforce and for the Government to deliver on its commitment of 6,000 more GPs.”

These are bankrupt pleas to a government that has conducted a homicidal policy of “herd immunity,” at the expense of the lives of many healthcare professionals, and which has systematically dismembered all parts of the NHS over a decade of austerity.

The only way to defend the NHS from privatisation is through the formation of new rank-and-file organisations of workers’ struggle, independent of the unions and the Labour Party. NHS Fightback, initiated by the Socialist Equality Party, supports the call by the International Committee of the Fourth International for an International Workers Alliance for Rank and File Committees and urges workers within the NHS to join this fight.