A general practice in Surrey found itself in the spotlight recently after revealing that three of its 11 salaried doctors had taken voluntary redundancy.1 The job cuts were said by the practice’s managing director to be due to changing patient demand and “a number of recent improvements and the introduction of new ways of working.”2 The practice states that it is working differently, with a significant increase in online requests and virtual appointments and a wide variety of new practitioner roles.3
When primary care networks were born in 2019, a budget was created called the Additional Roles Reimbursement Scheme, which would fully pay the costs of bringing other healthcare workers into general practice. There’s a long list of reimbursable roles, including physician associates, pharmacists, paramedics, social prescribers, and physiotherapists, but the scheme very specifically excludes doctors and nurses. GPs were reassured at the time that these people would work alongside doctors but that there was no intention of replacement.
Five years on, the core funding for general practice hasn’t kept pace with inflation.4 Practices are finding it harder and harder to afford to employ the salaried and locum workforce they need to meet their patients’ needs, and GP locums have found that work has dried up.5 Meanwhile, money is available to hire an array of non-doctors. A recent advertisement for locum physician associates offered £68 000-£90 000 with the requirement that the person had a two year physician associate qualification and at least one year of experience working in general practice.6
It’s very hard, at this point, to maintain that doctors are not being replaced by other healthcare professionals. The overall costs to the NHS are high, and it’s not at all clear what’s being achieved, apart from a positive political message that 31 000 more healthcare workers have been recruited.7 It’s also difficult to see how an efficient service can be offered, as so much of the work needs direct supervision by a doctor for safety.
And what does this mean for patients? There’s an element of Orwellian Newspeak in describing the changes as “improvements,” and I’d sincerely like to know how patients feel about these “new ways of working.” People who previously saw a GP at most appointments—someone who could confidently consult across the whole of medicine, investigate thoroughly, and prescribe safely—are now likely to see an allied health professional with a much more limited scope of practice.
There is a place for allied health professionals working alongside doctors in general practice, but this should always be complementary rather than as substitutes. The diversion of all investment in general practice into the primary care networks, and the exclusion of doctors and nurses from the Additional Roles Reimbursement Scheme, has led to financial difficulties for many practices and a worse service for patients.