Future recruitment of GPs to deprived areas

It was interesting to read Jacky Hayden's editorial where she said, ‘future recruitment of GPs to deprived areas will need sustained action’.¹ She is correct, but I am afraid the answer is partly to do with the ‘m’ word: ‘money’. I am painfully aware that medical royal colleges, because of their charitable status, are reluctant to go near ‘pay and rations’ issues; that is the job of the British Medical Association. However, when pay and rations get to the point that patient care and medical standards are at risk of starting to fall, then maybe medical royal colleges should say something?

It is already in the public domain that a GP with just a General Medical Services contract earns about £20 000 per annum less than a dispensing GP for the same sort of list size, who, by definition in England, are all in rural practices. Working where I do, in an island of deprivation in the centre of an otherwise relatively affluent central southern England, I see a lot of colleagues struggling with an unacceptably high workload for a below average remuneration.

Why is the workload high? Well, we all know that deprivation is linked to pathology, with the Quality and Outcomes Framework (QOF) really not covering the issue properly as we have a high number of defaulters, who cannot always be exception reported (I even hear stories of exception reporting being forbidden in the future!). Add to that the large number of social problems that somehow end up at the GP's door yet attract no QOF points, such as long-term sickness certification, endless requests for letters for appeals against refusal of benefit, letters regarding housing problems, substance abuse issues, the general ‘GANFYD’ (get a note from your doctor) society we live in, and one can see why the workload in deprived areas is high and demanding. In Germany, where primary care doctors are paid per consultation, the problem is getting GPs to work in the country areas, as the rural, relatively healthy, population go to the GP less often and income therefore falls.

I am writing this on a Sunday, knowing that already I have 20 patients booked in for tomorrow morning, and 16 for the evening. I shall probably do three visits, and perhaps handle about 16–20 telephone consultations in the day, as well as deal with the usual lab results and scanned letters. I am sure that is a familiar scenario to many urban GPs. For my four-and-a-bit days of work a week, I shall be earning a take home pay before tax of about £70 000 this year. A lot less than the Daily Mail headlines. I stay where I am because I work with a great bunch of doctors and staff, and because it currently suits me, but as I get nearer to retirement, the thought of leaving the NHS and going to do long locums in Australia for a couple of years becomes more and more attractive; especially with the current exchange rates. Why would any newly qualified GP want to come and work in an urban environment if they can get a post in a rural/semi-rural practice, or a post in a relatively affluent town?

I am aware that rural communities have their own problems and some degree of deprivation, but where I live just north of Southampton, ‘deprived’ means you drive a 6-year-old Mondeo rather than a Mercedes. ‘Jealous, moi?’ No – perhaps just a bit jaded, and fed up at hearing, from some colleagues who should know better, terms like, ‘failing urban practices’ as a fairly broad-brush term.