In September 2014 I wrote a blog about waiting times in General Practice, following a report in the Guardian newspaper about how increasing waiting times would impact upon the quality of care that patients receive. In that blog I mentioned a few examples of the more common problems that we see when mistakes are made in primary care. Since then, the government stated (in 2016) that it will be introducing “Crown (i.e. state-backed) Indemnity” for GPs, on the basis that a significant reason for the difficulty in recruiting GPs was the cost of medical insurance/indemnity. I gather (from my own GP) that the Medical Defence Union has already reduced its premiums for GPs on the back of this announcement. The government has also stated that it proposes to increase the GP workforce by 5,000 by 2020.

An interesting article in Pulse on 6 July 2018 claimed that “GP vacancy rates rocket with one in six roles unfilled”. The article states that “Pulse’s annual vacancy survey of 658 GPs found that 15.3% of GP positions are currently empty, up from 12.2% last year, and 11.7% in 2016”. Apparently, 1,000 GPs have left the workforce since 2015 and it seems that the government is well behind its 2020 target. As at March 2018, there were 33,574 full-time GPs in the NHS and over 41,000 GPs including those working part-time. These figures are believed to include GPs in training, though, and there is no guarantee that, even if they were to stay in general practice, such GPs will work full-time, as they will likely be better able to manage their onerous workload working part-time. Most GP practices are one GP short; and there are also significantly fewer GP practices in the country than there were a decade or so ago.

The government has supposedly also introduced 500 new medical school places and there are apparently 3,000 GPs presently in training. However, it takes at least 5 years to qualify as a doctor, let alone thereafter train to be a GP, and there is no guarantee of the number of those new medical students who will eventually become GPs, especially as statistics suggest that increasing numbers of new doctors would prefer to become consultants rather than GPs.

Although the Pulse study was small, all the evidence points to the fact that, since 2014, matters appear to have worsened rather than improved. There appears to be a disconnect with government, NHS England apparently having criticised the study as “tiny and unrepresentative”, notwithstanding that a primary care Professor at Imperial College London says the study supports the evidence that Imperial has. It is notable that when the government announced in 2016 its drive to recruit an extra 5,000 GPs by 2020, an analysis by Imperial suggested that, in fact, an additional 12,000 GPs were needed, in part because of the extent of part-time working. Of course, the government wants to be seen to be taking positive steps to increase GP numbers, so news of this nature is not helpful to its PR machine.

It is not just the cost of insurance that is the problem, though. Workload and work type (i.e. too much administrative and not enough clinical) are also issues, as is pay – an average GP partner in England earned c.£136,000 (uplifted) in 2004 when Labour agreed a new GP contract and, with successive contracts, that has been whittled down to c.£105,000. Salaried GPs earn a lot less (on average c.£63,000), which is also a lot less than an equivalent hospital doctor. However, insurance is a big issue – to date, a sizeable amount of a GP’s salary is spent on insurance premiums to the MDU, the MPS and the other Medical Defence Organisations (MDOs), whereas NHS hospital doctors have state-backed insurance through NHS Resolution’s Clinical Negligence Scheme for Trusts (CNST).

On average in 2016 the cost of indemnity premiums was about £7,900 per annum per GP; an increase from c. £5,000 per annum per GP in 2010. The MDU estimated in 2016 that indemnity inflation was about 10% per annum, which means that by 2018 that £7,900 will have become £9,500 per annum. Even having regard to just the 33,000 or so full-time GPs, one does not need to be a rocket-scientist to work out that that amounts to well over £300 million per year being paid by GPs to the MDOs for insurance. Whilst the MDOs are “not-for-profit” organisations and argue that the premiums pay for running costs, litigations costs and damages pay outs (all of which are also increasing), etc., this is still a very significant sum to be paying to the MDOs.

There is no doubt that state-backed indemnity for GPs, equivalent to the CNST, is in principle a welcome development both to GPs and to patients. What really matters is patients having access to GPs and GPs having the time and resources to manage their patients properly (as well as enjoying their job): hopefully this indemnity change will go at least some way to redressing the recent problems of recruiting and retaining GPs, even if it in and of itself will not be fully sufficient.