As an indemnity provider created by GPs for GPs, we pay close attention to the state of the profession. We’re acutely aware of the current shortage of GPs and the need to protect and support the skilled professionals who work across the country. In this post, we look at the latest set of data, which also shows which parts of the country have the biggest GP shortages.
GP numbers down since 2015
The number of GPs in England has fallen by nearly 1,000 since 2015 with 339 fewer full-time equivalent fully-qualified GPs in England in the last year alone. This news comes following an earlier report that showed the proportion of patients finding it difficult to get through to make an appointment with their GP had risen by 65% since 2012.
Doctors’ leaders say the average number of patients GPs should have on their list is 1,600 to provide a high-quality service. But, in September this year, the average number of patients per GP was a staggering 2,100. To maintain the top standards GPs want to set, it’s estimated that an additional 9,000 doctors would be needed.
Which parts of the country have the highest shortage of GPs?
The shortage of GPs affects different areas in the country in different ways.
The biggest overall fall in doctors since 2015 was seen in the North East (with an 11% drop) and the East of England (-7%).
The five areas of the country in need of the most GPs are:
- NHS Cambridgeshire and Peterborough (East of England), where the shortfall is 178 GPs
- NHS Birmingham and Solihull (West Midlands), 172 GPs short
- NHS Leeds (Yorkshire and Humber), 142 GPs short
- NHS Derby and Derbyshire (East Midlands), 138 GPs short
- NHS Nene (East Midlands), 128 GPs short.
The figures were published recently by the TUC. General Secretary Frances O’Grady said: “Our hardworking and overstretched GPs are working tirelessly to help patients. But there are simply not enough of them to keep up with demand.
“As a result, patients are not getting the treatments they need on time – and family doctors are stressed and overwhelmed.”
In 2018, a separate survey of 760,000 patients found 27.9% of them struggle to get through to their family doctor – a rise from 18.6% in 2012. On the back of that, Pulse magazine obtained data which showed that over the last six years, 585 practices have closed, covering a population of nearly 1.9million. Plus, in February, 42% of NHS GPs said they intended to leave or retire from the industry within five years, up from less than a third (32%) in 2014.
‘We need 5,000 GP trainees a year’
Responding to the latest NHS Digital data on GP workforce, Professor Martin Marshall, Chair of the Royal College of GPs, said: “General practice has experienced a workforce and workload crisis for a long time, resulting in many of the more experienced GPs burning out long before retirement.
“As a significant proportion of the workforce approach retirement age, effective retention strategies have to be implemented to keep people in the profession longer. It’s the only way more experienced GPs can have safe, sustainable careers in the NHS, both delivering patient care, and mentoring the next generation of GPs.
“On the positive side, recruitment efforts over recent years have seen the largest uptakes of GP trainees than ever before – and it’s something we are proud of. However, we need a steady flow of at least 5,000 GP trainees a year if were to avoid severe GP shortages.
“Reducing the undoable workload and having plans in place to ensure GPs don’t experience burnout is therefore imperative in keeping the frontline of the NHS safe for patients.”
‘We need to protect the nation’s hard-working GPs’
MDS CEO Rohan Simon added: “The latest figures are a concern and, yet again, show why we need to protect the nation’s hard-working GPs. We support any efforts being made to boost GP numbers as well as those to offer support to those currently in the post.
“When the Government introduced its state-backed indemnity scheme earlier this year it argued that high indemnity prices contributed to the low number of GPs. At that time we did say that this was just one factor – and that there should be a focus on other areas too. This shows that state scheme needs to be followed up with further action.
“MDS will continue to lobby the Government and lend its support to measures that would help GPs to have a better work life balance.
“MDS was established by GPs, for GPs. Its focus is to support the specific needs of GPs and is here to lend support wherever it may be needed. Ultimately, we want to ensure GPs can do their jobs to the best of their ability, with peace of mind that help is at hand when they need it.”
Need help or support in your role as a GP? Contact us to see how we can be of assistance.
How long medical records should be kept is a regular question asked by doctors, and with good reason. It’s a huge responsibility, and one that should be taken with great care, as record holders have a legal and ethical obligation to securely preserve records.
When it comes to the retention of medical records, there’s much to consider. There are also a number of differing circumstances, and some instances where records may need to be kept hold of for longer periods of time than the recommended minimum term.
It is also extremely important to keep in mind the principles of the General Data Protection Regulation (GDPR) when handling medical records. This is because a key principle dictates that personal data should not be retained for any longer than is necessary.
Clearly, however, what is considered ‘necessary’ can be interpreted in many different ways. It is vital, therefore, that if records are kept for longer than is recommended by health departments, the reasons are recorded and made perfectly clear.
In a time-pressured role and environment, effective record keeping is vital for all GPs. It’s important to become adept at maintaining records. It makes the job of a GP far easier when helping patients, and informing the time and care routes taken. In the same way that quality record keeping is key for protecting your judgement, it’s also vital to know how long medical records should be kept.
Minimum recommended GP record retention length
England, Wales and Northern Ireland
GP records should be retained for 10 years after the death of a patient, and electronic patient records (EPRs) must not be deleted or destroyed for the foreseeable future. These recommendations come from the British Medical Association.
The BMA took these minimum retention recommendations from the Information Governance Alliance Records Management Code of Practice for Health and Social Care 2016.
Increased patient access
During November, we discussed the importance of record keeping in healthcare and that patients will soon be able to access their records through an app with the NHS. The fact that patients will shortly have greater access and control over their medical data has brought into sharp focus what is being documented, the quality of that data and how long that data should be stored for.
There is also a whole section on the NHS website dedicated to informing patients about their health records, what is kept in those records and also how to access them.
What information can be included in the record of a patient?
The NHS informs patients that their record can include the following information:
- name, age and address
- health conditions
- medicines and treatments
- historical reaction to medicines and any other allergies
- scans, X-ray and other test results
- information regarding lifestyle, such as whether they smoke or drink
- hospital admission and discharge information
Take a read through our ‘importance of record keeping’ blog post to better understand the important considerations for good record keeping. This includes detailed information on what a patient’s clinical record should include and the other additional important details that should be documented along the way.
If you have any queries about keeping up to date, accurate records and need advice on how long you should keep medical records for, get in touch with MDS today to see how we can help and support you.
GP primary care services are not included in overseas visitor charging regulations, but with increased publicity, debate and recent rule changes over NHS charging, confusion can arise.
Whilst there may be charges for some overseas patients in secondary care, even people who are in the country illegally are likely to be entitled to free GP services and nurse consultations in primary care.
This premise has been maintained despite numerous reviews and consultations due, not in small part, to a sense that maintaining free access to GPs for all is in the best interests of public health, especially in terms of preventing the spread of communicable disease.
Additional confusion may arise due to variations in legislation between England, Northern Ireland, Scotland and Wales.
NHS entitlement for non-residents
In England, treatment in Accident and Emergency departments and at GP surgeries is free for all, including non-UK residents.
This position was reinforced by Government charging reviews and consultations in 2012, 2013 and 2015.
Sustaining services, ensuring fairness: Government response to the consultation on migrant access and financial contribution to NHS provision in England made plain that people in the UK illegally or on temporary visitor visas were included in this and do not have to pay for GP services.
Even where a patient is refused registration with a GP practice for appropriate non-discriminatory reasons, any immediately necessary treatment must be provided free of charge for up to 14 days.
A broadly similar framework is in place across the UK currently in terms of charging overseas patients, but as it is a devolved matter, variations may exist in Scotland, Wales and Northern Ireland. It is important to be aware of the localised regulations.
Rules around registering non-resident patients for GP services
Department for Health and Social Care guidance on implementation of charging regulations states, that anyone in England can register as an NHS patient and consult with a GP, non-residents included.
There have been cases where GP surgery staff have not fully understood this, and their responsibilities in regard to ensuring people are not blocked from registering based on not having a residential UK address.
There is no minimum threshold on the amount of time someone has to have been in the UK before they register with a GP.
GPs cannot refuse to register patients on the grounds of race, religion, appearance, gender, sexual orientation or medical condition.
NHS guidance states that a patient cannot be refused due to not having identification or proof of address. This is to protect recent migrants and vulnerable patients including asylum seekers, refugees, overseas visitors and the homeless.
GP responsibilities in relation to identifying chargeable patients
GPs in England must provide new patients with the revised GMS1 registration form, which includes a section for patients to provide information to help determine eligibility for free NHS secondary healthcare.
However, it is not the responsibility of GP practices to identify chargeable patients. It is down to the body providing chargeable NHS services to establish eligibility.
Hospital Overseas Visitor Managers are advised to seek to establish contacts with GPs to help them fulfil their obligation to identify chargeable patients, but confidentiality responsibilities do need to be maintained by GP practices.
All personal information shared by a patient with their GP is confidential, including demographic data. Doctor-patient confidentiality should be closely protected in relation to all information shared. Generally, consent should be sought to share information where appropriate, and it should usually only be shared without consent where there are exceptional and justifiable circumstances, such as the prevention of serious harm or in detection of serious crime.
GPs should not make judgements over eligibility for secondary care, and should refer wherever clinical grounds demand it. Even if a previous referral has led to a conclusion that a patient is not eligible for free care, new referrals should be made in the same way as usual – circumstances may have changed or need may have become urgent.
GPs may wish to advise patients that a referral does not mean they will be entitled to free secondary care. Displaying posters regarding NHS entitlement may be advisable.
The requirements and rules in relation to registering patients and identifying chargeable patients are not standardised across the UK, and it is necessary to be aware of country specific legislation.
Mistakes in interpretations of rules and requirements in terms of registering overseas patients, approving them for treatment and information sharing can all lead to negative outcomes for patients and practices. It is vital to have a grip of rules and for staff training to remain updated.
Legal advice is available 24/7 to MDS members.
As medical negligence or other claims may arise after you retire – or stop practising for some other reason – you need to ensure you are covered for the long term.
Run-off insurance for GPs is a type of cover that specifically relates to historic claims from a time when you were practising.
Not all GPs will need run-off cover in order to deal with historic claims as it depends on the type of cover held while you were practising.
It is the responsibility of doctors to ensure they get insurance to cover the full scope of their practice, including run-off cover where necessary and appropriate.
What is run-off insurance for GPs?
Run-off insurance provides cover claims against a doctor or their estate made after they retire, die or are no longer practising for any other reason. It is legacy cover.
In cases where doctors have always held occurrence based indemnity there is no need for run-off cover. This is because occurrence based indemnity provides cover relating to the time when the incident occurred, regardless of when the claim is made. For this reason, all cover provided by Medical Defense Society is occurrence based.
Those who hold claims based cover need to consider run off insurance as that cover only pays for claims made during the policy period.
Who needs run-off insurance?
Run-off insurance is generally for those who have stopped practising or have retired and, crucially, held claims based rather than occurrence based indemnity while they were working.
Doctors who bought a claims based indemnity cover as a transitional product in the run-up to the introduction of Clinical Negligence Scheme for GPs (CNSGP) were initially advised they would need run-off cover.
It’s vital that GPs check if they were one of those and ensure they have sufficient cover in place. However, agreements have now been reached in many cases for the government to take on historic and existing liabilities predating CNSGP.
When the Government scheme was introduced in April 2019, the Department of Health and Social Care noted CNSGP would not act as run-off cover for those who had previous claims based products. However, there have been successful challenges and subsequent agreements over this.
What is the time limit for medical negligence claims?
Medical negligence claims can be brought years after an incident occurs.
While there is a three-year limit on medical negligence claims, it doesn’t exclude the possibility of proceedings being brought much later.
The three-year time limit states that claims must usually be brought within three years of either the incident or when it was first realised injury had been suffered.
The three-year limit does not begin until the 18th birthday of a child and, in the case of a mental disability, it doesn’t apply unless the person recovers from it.
So, while after three years the risk of an historic claim is likely reduced, the decision over how long to retain run-off cover may be complex.
Do you need advice about run-off cover? Contact us with your indemnity queries.
All of us as GPs will likely carry out at least some paid-for services, but expansion of or an outright switch to private delivery is, obviously, a wide-reaching decision.
It’s one thing to provide HGV medicals and firearms reports that don’t conflict with NHS services and another to step into a for-profit frame of mind.
Whether you are debating joining an existing private practice or forming one yourself these six preliminary considerations may be helpful thought prompts.
1. Moral arguments
Few GPs considering branching out into offering private services will do so without some consideration of the moral arguments.
The debate is one that only individuals can come to a conclusion on but it’s worth remembering with this emotive issue that you’re likely to face strong views in opposition to your own. You may need to be patient with others and develop a thick skin.
As well as the wider conflict over whether or not private services are detrimental to the NHS, there are personal considerations around adjustments to dealing with profit being a factor in care.
If you are seeking to work for a private practice, rather than establish one, close scrutiny of procedures and practises, such as prescribing processes, will allow you to evaluate if your personal beliefs align.
2. Robust division between private and NHS work
Should you be considering running a private practice or perform private work alongside an NHS practice you’ll need to ensure you have robust procedures to keep the two distinct.
The 2019/20 NHS contract prevents signed up GP practices from hosting or advertising paid-for services that fall within the scope of NHS funded primary medical services.
3. Financial arrangements
In private practice you’re likely to need to deal with the priorities and expectations of investors or shareholders either in a direct or indirect way.
For those setting up private practice themselves, specialist accountancy and business advice may need to be tabled, not least in relation to dealing with private medical insurance companies.
Marketing also requires investment and expertise.
4. Revalidation and appraisal arrangements
In private practice you’ll have the same revalidation and appraisal obligations in order to retain and protect your registration.
Processes to allow effective completion are vital.
5. Patient expectations
Patients’ expectations among the privately funded bring different demands to those experienced in the NHS.
Some paying patients might well demand tests or treatments that may be clinically ambiguous.
6. Indemnity cover
A move into private practice brings the need for further consideration of indemnity cover for yourself and staff if you’re employing them.
While the 2019 introduction of the Clinical Negligence Scheme for GPs (CNSGP) did not negate the need for indemnity cover even in traditional, majority NHS practices, in private practice cover must be robust.
The state-backed scheme offers automatic cover for liabilities relating to acts or omissions relating to the diagnosis, care or treatment of a patient in relation to NHS services only. It’s worth remembering that even private actions that are permissible in NHS practice are not covered by this scheme, which can cause confusion where there are grey areas, in relation to travel vaccinations, for example.
Terms of engagement should be among other legal considerations.