Why it’s important to see the SAME GP

Patients at surgeries with a high turnover of GPs are more likely to need emergency hospital treatment than those with steady care, a study has found.

Family doctors with revolving staff were less likely to offer same day appointment or let patients see their preferred doctors.

Experts said the findings should serve as a ‘wakeup call’ for primary care and were particularly worrying given the number of practices with a high turnover has more than doubled in a decade.

Researchers at the University of Manchester studied an average of 7,526 practices each year from 2007 to 2019.

Family doctors with revolving staff were less likely to offer same day appointment or let patients see their preferred doctors

They found ‘persistent high turnover’ – defined as when more than 10 per cent of GPs changed in a practice in at least three consecutive years – was not uncommon.

It affected 2,309 of English practices – more than 28 per cent – at least once between 2009 and 2019.

Those with changing staff were found to have an average of 1.8 more emergency hospital attendances per 100 patients than those who kept the same doctors.

Researchers found 5.2 per cent fewer people saw their preferred doctor and 10.6 per cent fewer people reported getting an appointment on the same day.

Patients reported lower overall satisfaction with their practice, according to the findings published in the journal BMJ Quality and Safety.

Co-author Rosa Parisi said: ‘This study is a wakeup call for primary care and for the first time gives us clarity on one of the major problems affecting it.

‘We think high GP turnover is likely to affect continuity of care, and that might explain why avoidable emergency attendances are more likely to happen.

‘Indeed we know from previous studies that continuity of care is deeply important to patients.’

The highest levels of ‘persistent high turnover’ were in Cumbria and the North East, South Central and the West Midlands.

Practices with ‘persistent high turnover’ also tended to be larger, located in more deprived areas and had a higher health burden from serious chronic conditions.

The pressure of managing patients with more complex health needs with no additional resources was likely a factor in the high turnover, they said.

The researchers observed a worrying increase in the practices affected in a year, from 2.7 per cent in 2009 to 6.3 per cent in 2019.

They highlighted workload pressure, limited opportunities and contribution to decision making and the management of their practice, particularly salaried GPs, with lack of funding and investment from the government.

Latest figures suggest general medical practices have lost the equivalent of around 1,900 full-time fully qualified GPs since 2015, although the number in training has risen.

More than a quarter of practices have closed or merged in the past ten years, with patient lists increasing by a fifth to nearly 2,300 for each GP in England.

Co-author Professor Evan Kontopantelis said: ‘This study shows practices with persistent high GP turnover need more support from local and national authorities.

‘There is a desperate need for policies to maximise retention of GPs and personal and professional support, targeting areas which influence job satisfaction and work-life balance.’

Professor Kamila Hawthorne, chair of the Royal College of GPs, said: ‘GP teams try to do their best for their patients to deliver high-quality, holistic and safe care, but the intense pressures in general practice are causing many GPs to rethink their future careers in the NHS.

‘Some move from practice to practice, looking for better working conditions, but many are leaving the profession all together due to burnout.

‘This is sadly likely to get worse, with a recent College survey suggesting the profession is facing an exodus of 15,000 GPs in the next five years.’

A Department of Health and Social Care spokesperson said: ‘We recognise the pressures general practice teams are under and are working to increase access for patients.

‘This year, general practice teams have delivered over 70,000 more appointment every working day than before the pandemic and we plan to deliver over a million more appointments this winter by bolstering general practice teams with other professionals.

‘As of September 2022 there are almost 2,300 more full time equivalent doctors working in general practice compared to September 2019 and we have recruited over 21,000 additional staff.

‘There are also record numbers in GP training, and have attracted hundreds of doctors to train in hard to recruit areas since 2016 through targeted incentives.’

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