“The hub is our opportunity, and we can’t risk losing it”

Dr Matthew Fallon, GP Partner at Claremont Bank Surgery, Shrewsbury writes:

Across our county, all GP practices are under extreme pressure because of increasing demand, workforce problems and estates issues. This is a national problem not just a local one, but that doesn’t make things any better.

Since the pandemic, healthcare professionals including GPs have been leaving in their droves. They state similar reasons – overwhelming amounts of work, burnout and a desire for a less stressful life. We face a serious workforce issue across the county and indeed the country, and something needs to change.

Despite running several GP recruitment, retention and training programmes, workforce numbers remain an issue. If we can’t staff our GP practices, who will see the patients who call for appointments each day?

There is a current shortfall of at least 4,200 GPs across England. According to the latest figures from the British Medical Association (BMA), there are 1,808 fewer full-time GPs in England today than there was in September 2015, while each practice has on average 2,131 more patients.

A recent Royal College of General Practitioners survey also found that 42% of GPs in England were “likely or very likely to leave the profession in the next five years”, with nearly half of those suggesting burnout or stress as the prime reason. The statistics don’t lie; they are black and white back-up to what GPs have been saying for years and it is a dire situation.

There isn’t a quick fix to these issues. Much of it boils down to funding and a lack of medical training places. I hear a lot of cynicism aimed at so-called ‘part time GPs’ and yes, some of us have contracts that are not full-time working hours or days, but this is due to the sheer stress and pressure we are under on the days we are in practice.

These are not 9-5 jobs; they can often stretch to 12-hour shifts with a mountain of admin behind the scenes that we must complete after the last patient has been seen after a very busy day.

General Practice is experiencing an unprecedented rise in patients seeking medical help. There is a domino effect across the entire NHS – if A&E is busy, people go to their GP. More and more people are accessing General Practice services because it’s quicker and easier to be seen when you need medical help. At our practice we have space for 190 appointments each day, 950 appointments each week. However, demand for these can easily be two-fold and by Monday, approximately half of the appointments for the week (between 420 and 475) are usually already booked.

Dealing with the negativity is an ongoing problem. We are concerned about losing more staff – our receptionists are tired of being shouted at. They can’t magically make time appear for me or my colleagues. We are genuinely trying to help, and just as frustrated as patients are. Prioritisation, telephone consultations, four-week non-urgent bookings are a necessity rather than a choice.

As it stands, if you really need to see a GP within a day or two, you will. But if it can wait, then sadly it must. We need to make appointments available for those who are in greatest need, and our receptionists are trained as care navigators to ensure people are seen when needed. So, where does that leave us?

Claremont Bank Surgery is one of the six GP practices that has expressed interest in being part of the Shrewsbury Health and Wellbeing Hub – a new development which would integrate a range of services in one environmentally-friendly building which would be owned by the local NHS, rather than GPs themselves.

There are many good reasons why our practice feels this is the only way forward for us, and I know this is the case for many of my colleagues within the five other practices. To deal with increased demand and long term, complex conditions we need to provide specialists who can focus on co-ordinated, person-centred care as well as better continuity of care.

The Shrewsbury Health and Wellbeing Hub would be large enough to accommodate additional clinicians such as Advanced Practitioners, First Contact Physios, Pharmacists and Social Prescribers in addition to support staff to manage the increase in clinical workload.

This, as well as integrated neighbourhood teams, would enable shared learning between professionals and could improve not only the medical but also the lifestyle and social factors which impact on a person’s wellbeing.

This isn’t a merger, but it will be a big help to be in the same building as other practices. We will retain our own identities, have separate reception spaces for check-in and waiting rooms, plus the building will be light, spacious and easy to navigate for our patients.

The hub would also mean releasing the financial burden and worry of maintaining our own GP buildings, sharing estates cost, maintenance and upkeep. We’ll also be in a far better position to attract staff to work within state-of-the-art facilities and with modern equipment. Many young doctors prefer not to be tied into the financial stresses of being a GP partner, so the hub would enable us to recruit with far greater ease.

Not only is this a real opportunity to be part of a much-needed shift in General Practice, but it will also provide us with the chance to become pioneers of a new ownership model and to drive change for the better.

The hub will mean better integration of health and wellbeing services – all under one roof – and it could provide our town with an opportunity to create a centre of excellence, a beacon for the future of NHS property development in England.

Despite all of this, my vision for the future of General Practice is simple. It feels like we don’t have time to fully care for our patients anymore. A quick 10-minute appointment, and then onto the next. I’d like to get to the point where we can meaningfully cater for our patients in a personalised way, looking at the whole person and all that comes with that.

I also want to work within a setting that caters for the whole community, with GP colleagues retaining that integral role as family doctor - something that attracted many of us to the profession in the first place. That’s my ideal. I see this as our opportunity to take now, and we can’t risk losing it.