The substantial recent rise in criminal acts of violence at GP surgeries across the UK should be a wake-up call for the health secretary and the public. Pressure on primary care has been building for years. The situation is now increasingly alarming for doctors as well as patients. A freedom of information request by the British Medical Journal (BMJ) revealed that police are recording an average of three violent incidents at surgeries every day. GPs have told the Guardian of angry patients breaking doors down and threatening to stab them.
This is dangerous for doctors and other staff, particularly receptionists in public areas. While attacks on hospital staff have also increased, there is a different dynamic in GP surgeries, which are smaller and do not have the same security arrangements.
Ministers have been promising for years to address the UK’s GP shortage. In 2015, when he was health secretary, Jeremy Hunt pledged to increase the number of GPs in England by 5,000 – a number later increased to 6,000. But the number of family doctors has fallen. From 29,364 full-time equivalents in 2015, the overall figure fell to 27,939 in 2020. There are also GP shortages in Northern Ireland, Scotland and Wales.
Aside from the threat of violence itself, the obvious risk is that recruitment and retention of family doctors could become even harder. The irony is that becoming a doctor is widely seen as desirable, and entry to medical schools is highly competitive. But the evidence of increasing numbers quitting the profession shows that for many, the work fails to live up to expectations – or that, over time, the stress starts to outweigh the rewards.
When she retired, Clare Gerada, a former chair of the Royal College of GPs, described how sad she felt about the way that her relationships with patients had been “eroded and devalued”. One-third of GPs are planning to leave their roles within five years, according to a survey carried out in April. The proportion among those over 50 was two-thirds.
Lack of investment is a huge part of the problem. Parts of the NHS have been running on empty for years. The refusal of ministers to accept the need for a long-term workforce strategy, with clear targets for recruitment, seriously undermines Conservative claims to support the NHS. By letting these holes in the workforce keep on growing, they jeopardise its future – and create opportunities for private health businesses.
But underfunding is only part of an increasingly complex health policy picture. The reality, recognised by doctors and policymakers, is that healthcare has become more complicated as increased longevity and advances in medical science have led to more people living for longer with multiple conditions. Rising rates of obesity and dementia have placed new demands on health and care systems. Brexit has also played a part. Prof Martin Marshall of the Royal College of GPs blames “nonsensical” immigration rules for making it harder to recruit.
Last year, Sajid Javid unwisely joined in a press campaign aimed at pressuring GPs to restore pre-Covid working practices. The BMJ’s research shows just how irresponsible some of this rhetoric has been. Ministers should speak up for GPs, and explain how they plan to address the mismatch between demand and capacity. The situation with NHS dentistry, with some areas now “dental deserts” where those who cannot afford private treatment go without, is a cautionary tale.