The rising pressure on practices

Catherine Lawler, PMA, discusses the pressure on GP practices and how you can regain a feeling of recognition 

We’re all acutely aware of the massive strains in general practice, with rising – many would say unreasonable – demands on GPs, practice nurses and practice managers. Unrealistic workloads, confrontational patients with unrealistic demands, far too much pressure, and unfair media spotlighting has meant that practices, right across the country, are struggling to both keep and recruit staff and morale seems to be at an all-time low.

As stated in the BMJ in May last year, primary care is rightly called the ‘bedrock of the NHS’ dealing with around 90% of patient contacts for under 10% of the national budget; if general practice fails, the entire NHS will collapse. 

In order to ‘temperature check’ the state of practice management PMA created a survey – completed by almost 1,400 people – the majority of whom have been working in practice management for up to 20 years. They were asked if their role had changed significantly in the last year (for reasons other than COVID) and what their biggest concerns were; there were other key questions related to wellbeing, job prospects and professional recognition.

Many openly shared their concerns about their work – and it made for stark reading. For example, roughly a quarter of respondents are considering leaving general practice in the next year with comparable numbers expecting to leave in the next three-to-five years. Part of this apparent exodus will be down to natural erosion, as at least 30% of senior managers are planning to retire, but it is still a very significant amount of people. Their reasons include workload stresses, lack of home/work balance, sheer exhaustion, lack of support and recognition; only three per cent expressed dissatisfaction with their salary. When asked about wellbeing nearly 83% admitted to working longer hours than contracted to do and almost 80% are feeling exhausted by their work in general practice. 

But what can be done to improve the situation? We asked – and there were numerous suggestions including more understanding from GP partners and a reduction in red tape for NHS, CCGs and PCNs – something that has been an issue since long before the pandemic. It was also felt that there should be more specialist, non-clinical, roles and much more backing and support from NHSE following the intense media negativity towards general practice. Press hostility to practices was so harsh that it led to more than 1,600 GPs, and hundreds of other signatories, backing a complaint to the press standards watchdog over articles on access to general practice.

Bearing the brunt

Practice managers and receptionists often bear the brunt of patient animosity, and it has been a particularly challenging time for them. Interestingly, it was felt that professional recognition could, potentially, make a critical difference to how motivated and respected managers in general practice feel. 

In the areas where PMA can address some of these concerns, we have done so – PMA professional membership provides long-overdue recognition of the significant skills and value delivered by all managers and their team members, and is free of charge for the first year. An experienced practice manager could expect to gain PMA professional or fellowship levels, and there are also membership options for all practice team members, including students and apprentices.

We want to share insights from this survey far and wide to help bring about change within the primary care sector – while also doing our bit in turning a negative into a positive. Key recommendations include partnership opportunities and incentives for non-clinical managers and a need to support effective succession planning; large numbers of managers planning to retire, or leave general practice, in the next few years will create huge numbers of vacancies without the resource available to fill them.

Finally – going back to poor patient behaviour – this is a subject that keeps cropping up regularly and has definitely become more prominent of late, causing a great deal of concern and stress. It has been suggested that a zero-tolerance approach may be the answer. PMA would support a government campaign educating patients about the challenges faced by practices and encouraging a more considered and collaborative approach by patients –  resulting in a more effective way forward.