NHS Primary Care: Current Issues and Challenges – Hot Topic

The general practice services offered by the NHS are vital in terms of the functioning of our healthcare system. They act as the first point of call for healthcare services to the public. Many people go to the same general practitioner (GP) for many years and can form good doctor-patient relationships during this time. However, whilst there are many positive aspects to the NHS’ GP service, it does come with its own challenges. This makes it a commonly questioned topic in medical school interviews. This article will provide you with some of the relevant issues and challenges general practitioners face.

What are some of the current issues associated with general practitioners and primary care?

GP shortage:

There is a shortage of general practitioners in the UK compared to what is needed. This is down to multiple reasons, there are more GPs retiring or leaving the specialty than the number of doctors entering it. There are a couple of reasons as to why this may be:

• It can be quite a stressful job with a high workload. GPs are expected to carry out 10-minute consultations, including taking a history, carrying out an examination, discussing the diagnosis, and coming up with a management plan through a collaborative approach with the patient. This can be quite demanding, which can mean appointments tend to run delayed.
• There is a lot of paperwork/ non-clinical work involved with being a general practitioner.
• There is also an increase in population which means that more general practitioners are required to treat these people.

GP practices are closing down:

In the last decade, the number of GP practices has fallen by 20%, pairing this with the increase in life expectancy and increase in population, it is no surprise that there is a shortage of GPs.

Long waits for appointments:

The waiting time for an appointment has reached a new high, with over 30% of people waiting over a week for their appointment.

Public satisfaction with GP is low:

A study in 2019 conducted by the National Centre of Social Research stated that public satisfaction with general practice is lower now than it has ever been before.

Solutions for the GP shortage crisis

• Increase the number of medical school places and GP training programs – the government is currently working on increasing the number of medical school places by opening up new medical schools within the UK. Incentives can be put in place for entering the specialty of primary care.
• Retention of current GPs – this can be done by improving the current working conditions faced by GPs by addressing workload and administrative issues. More roles that incorporate flexible work schedules, would decrease the number of GPs leaving due to family or personal commitments.
• Addressing the uneven distribution of GPs – there are certain rural areas that have unfair disadvantages when looking at the proximity of general practices. Incentives can be put in place for doctors to work in these remote locations.
• Increase the use of digitalisation in general practice – after COVID there has been an increase in telephone consultations, this can be used more frequently to reduce the workload of GPs.

Role of Physicians’ Associates in GP

To help with the strain placed on general practitioners, more PAs have been hired to mitigate some of this extra work. Physicians’ associates are mid-level medical professionals who are trained as generalists. As of October 2024, new guidance has come out regarding the role of PAs in primary care; the guidance states that PAs should see patients who have been triaged by the GP and undertake work that has been delegated to them. This can be beneficial to doctors by freeing up more time and preventing burnout in the long run.

Medical School Interview questions & model answers:

What is the role of a GP?

The role of a general practitioner is to be the initial point of access to the healthcare system, GPs work out in the community rather than in a hospital. Patients will present to them with either new acute symptoms or as part of the management of a chronic long-term condition.

How does the current GP shortage crisis affect the public’s perception of general practice?

The role of general practitioners is vital in the functioning of the healthcare system in the UK, with this shortage of GPs there is a direct effect on patient care. This manifests in different ways such as increased waiting times for appointments, GP closure may result in patients having to travel further to see a GP and increased levels of public dissatisfaction with the service. All of these will negatively impact the public’s perception of GPs, which in turn may cause hesitation amongst the public before deciding on whether to seek a GP appointment. This can ultimately lead to later diagnoses and poor patient care.

What do you see as the biggest challenges facing general practice in the NHS today?

One of the biggest challenges affecting GPs is the increase in demand and the strain that this puts on the general practice service. Ultimately this is largely due to 2 factors:  the ageing and growing population in the UK and the shortage of GPs. This mix leads to results in more patients seeking appointments than the system can accommodate. The strain that this exerts on the working GPs can lead to many doctors feeling burnt out and overworked; by trying to fit in seeing all the patients as well as completing all the accompanying administrative work.

What do you think are the benefits and drawbacks of using telemedicine in general practice?

After the coronavirus pandemic, general practices have been increasingly using telephone consultations as a form of either following up on patients or assessing patients whose presentations may not require a face-to-face appointment. Telemedicine has many benefits, especially in terms of accessibility and convenience. It also helps with a smoother running of consultations as no time is wasted getting patients in and of the consultation rooms. Telephone consultations also allow doctors to reach patients who have difficulty getting to the appointment, whether it be due to rurality or mobility issues. However, whilst this may seem like a good solution to many of the challenges general practices are facing, it also has some drawbacks. By having the consultation remotely, it does not allow the doctor to physically examine the patient, which could lead to missed diagnoses. It is also important to remember that certain empathetic and non-verbal communication methods that would have been used in a face-to-face consultation cannot be used in these cases, making certain consultations harder. Additionally, there are certain patients who may have difficulty in either using or accessing technology.

Other possible medical school questions on this topic:

• Discuss the role of multidisciplinary teams in general practice. How could they help alleviate pressures in primary care?

• How could NHS policies support GPs in balancing clinical duties with the administrative tasks that often contribute to burnout?

• Discuss the importance of continuity of care in general practice and the challenges of achieving it in today’s NHS.

• What impact has the COVID-19 pandemic had on general practice in the NHS, and how could GPs adapt to these changes in the long term?
• How do you think the ageing population in the UK affects general practice and what strategies could be used to address these challenges?