When something aches or you feel bad, the first place to go or call is the General Practitioner (GP). The NHS designed GPs as the entry point for most health-related issues. The aim of this system is threefold: (1) to get patients quick access to a medical doctor in his or her vicinity, (2) to have the GP assess the problem and either treat the patient on-site or refer the patient to a specialist, and (3) to optimise more expensive specialists’ time by only seeing patients that need to see a more advanced doctor.
So far so good. But a recent study by the Health Foundation suggests that by the end of this decade around a quarter of needed GPs will have left the labour market without being replaced. The NHS GP shortage should be taken seriously: If this unfolds the more specialised parts of the NHS might get overrun by patients and a domino effect could occur bringing down the entire care system in England.
But just recruiting another 10,000 GPs without changing the current NHS GP system might be hard to realise. So let’s look at the reasons for the looming shortage and incentives that could get us out of this situation.
A massively centralised system such as the NHS will over and over again encounter shortages of capacity, human resources, and drugs given its top-down funding structure. The predominant compensation driver for GPs is how many patients are enlisted with their practice – morbidity, quality of care, and efficiency of care play merely minor roles.
A much more decentralised outpatient care system that champions private clinics and private insurance at competing rates will be much better suited to quickly react to looming shortages by individually adjusting the pay of staff and the compensation for clinics. Patients might want to pay more for seeking care nearby or pay extra for same-day appointments.
One of the fundamental problems with highly centralised and politicised systems is that often patients have to figure out which practice can actually still accept patients. In a more agile system, the money needs to follow the patient and not the patient the money (the allocated resources in the system).
The NHS is not the envy of the world, no matter how often English politicians repeat that phrase. Even social democracies such as Germany rely much more on private elements in their primary health systems than the UK does – Switzerland and the Netherlands are two great examples. Patients should be much more in charge of deciding how and where their health contributions should be spent.
One idea to make it more attractive for medical students to choose a career as GP is creating healthcare vouchers that cover the basic NHS package for GPs (around 160 GBP/year and patient) but allow patients to redeem their vouchers at non-NHS practices and pay the difference out of pocket if these are more expensive or have the difference reimbursed by supplementary insurance. This would allow GPs to increase their profit and at the same time allow patients to transfer resources allocated within the NHS to a practice of their choice.
Opening up medical education to private universities in order to bring up the annual output of graduates from medical schools should also be one driver for more doctors available. Education, as healthcare, is too centralised and hence bottlenecks are inevitable.
At the same time, we need to make it easy for medical professionals from other countries (EU and non-EU countries) to migrate to the UK and quickly (maybe even immediately) work as GPs or specialists. I personally heard from medical doctors who emigrated to the UK what bureaucratic and certification ordeal they had to go through in order to practise in England.
Let’s keep in mind that the talent pipeline from admitting a student to a medical college to having a GP is pretty much a decade. A quick change of the approach to primary care in England is needed if this problem should be successfully tackled.
Originally published here