Getting a GP appointment should be a lot easier next year

Morning members — and welcome to today’s edition of The Tribune. 

A very different version of this piece could have landed in your inbox yesterday morning but, by the pricking in our thumbs and the shape of our tea leaves, The Tribune formed a notion there was something big coming down the line. It’s fortunate that we held off, because it would have been pretty embarrassing to publish a piece about why it’s so hard to get a GP appointment, only for the new government to announce a pretty decent remedy that same day. Instead, here’s a positive news story to start your weekend with.

But first, if you know any journalists based in London, remind them that they only have until the end of this week to apply for a job at our upcoming publication down south! Find out more on our parent company’s website here.

Your Tribune briefing

🏬 Eight shop front and first floor offices on Chapel Walk are to be restored thanks to a £250,000 grant from Sheffield Council. The money will be given to the Church Burgess Trust which owns the Howard Building in which the shops and offices are situated. The Star says the aim of the funding is to attract new businesses and visitors to the historic walkway which dates back to the Middle Ages but in recent years has struggled due to a lack of maintenance.

🏰 A good one for history buffs: appropriately-named archaeology publication The Past has published an in-depth report on the excavation of Sheffield Castle, which has also revealed the remains of the city’s more recent history. “We now have an opportunity to put the city’s origins back on display,” Ashley Tuck of Wessex Archaeology told their reporter, “and in doing so revive this area’s fortunes and make it part of the community again.” Our piece on the dig is here.

🎹 If you follow us on X (and if not, why not?), then you’ll already know that Claudia Winkleman was filming an episode of Channel 4’s The Piano at Sheffield station earlier this week. If that’s not quite enough lurid detail for you, however, BBC Radio Sheffield covered the news on their show — have a listen here. 

Things to do

🖥️ Today at Site Gallery, a new exhibition opens celebrating the first cyber cafes, which acted as a site for optimism and excitement at the early potential of the internet. The gallery’s young people’s collective Society of Explorers have collaborated with artists Antonio Roberts and Lucy Cheesman to design an interactive show to reimagine the creative potential of the internet cafe of today. The exhibition runs until 8 September and we’ll have a piece on it coming soon.

🎮 Also today at Forge Warehouse, the Berlin-based international videogames and “playful media” label A MAZE. will hold their first ever event in the UK. An annual international festival of arthouse games and playful media, A MAZE. have held acclaimed pop-up events all over the world supporting a global movement of independent and meaningful games culture. The event runs from 10am until 3am the following morning and includes workshops, talks and live performances.

🍻 On Saturday at the Cambridge Street Collective, Jules Gray from the Hop Hideout speciality beer shop will deliver a guided tasting of five hand-picked summer beers perfect for quenching your thirst. Jules will share her insights about the five beers, taking you through the brewing process, history, ingredients and flavours, and explaining the unique attributes that makes each one the perfect summer serve. The session runs from 7.30-9pm and tickets are £17.50.

🎉 We mentioned these earlier in the week but just to remind you that tonight is the start of the first ever Sheffield Film Festival at the Showroom Cinema, and the Abbeydale Road Beer Festival (which is taking place across 12 bars in Nether Edge) began yesterday and finishes on Sunday. Have a great weekend!

Getting a GP appointment should be a lot easier next year

Rebecca (not her real name) is one of three trainee GPs based at a practice in Sheffield, who are all about to finally qualify — after years of medical training — in November and December this year. Once upon a time, it would have been taken for granted that all three doctors would get their first proper job at the practice where they completed their training. In this case, there’s not even room for one of them. “We all want to stay in Sheffield and we all want a job,” Rebecca says, “and, at the moment, none of us have one.”

Where is this practice, you might be itching to know, with its cup running over with doctors? And can they see me about this skin thing I’ve been trying to ignore, because my local GP has no appointments for the next month? “Whenever I tell anyone that I’m nearly qualified,” Rebecca says, “they assume there must be lots of jobs because every practice says they need more staff.” The practice currently unable to employ her or her fellow trainees is no exception. Everywhere needs more GPs, so they can see more patients, but almost nowhere is hiring.

That’s not just Rebecca’s impression; it’s a demonstrable fact. Every month, Sheffield’s Local Medical Committee puts out a bulletin of job vacancies in primary care. In early 2023, each issue had a significant list of ads calling for GPs: 13 ads in the January edition, 14 in February, and so on. This year, however, there were just four GP jobs being advertised in January and February, while in June, there were none. The most recent bulletin, from July, even had a notice from a GP with a decade of clinical experience, urging practices to contact him if they could offer work.

“That made me feel a bit rubbish,” Rebecca admits. “Part of the reason I trained as a GP was because I was told there was very much job security.” She’s in her early thirties, with a mortgage and a new baby; she knows she and her husband can’t survive off his salary alone for long. At a time when she’d like to be focusing on her child and finishing training, she’s having to contact practices directly begging for work. “It’s just another level of stress.” 

Several local doctors who spoke to The Tribune earlier this week argued that a simple change to the rules around funding for primary care would make it far easier for Rebecca to land a job. Alan (not his real name), a local GP partner of 14 years, explains it best. In 2019, in response to a shortage of GPs, the Conservative government introduced the Additional Roles Reimbursement (ARR) Scheme. The scheme aimed to reduce GPs’ workload by paying the salaries of specialist medical staff to support them, such as pharmacists and physiotherapists. However, practices were not allowed to spend this money on hiring more GPs, something many in the medical profession have been arguing needs to change.

When The Tribune approached the Department of Health and Social Care earlier this week, they sent back a disappointingly vague statement. “This government is determined to fix problems in general practice, which is critical to making the NHS fit for the future,” a spokesperson wrote. “We will increase the proportion of resources going into primary care over time and help address the issues GPs face.”

The good news is that today, the government announced that it will be putting that simple fix into practice and scrapping the limitation. “More than 1,000 newly qualified GPs will be recruited thanks to government action to remove red tape currently preventing surgeries from hiring doctors,” a press release crowed. “It is absurd that patients can’t book appointments while GPs can’t find work,” said Health and Social Care Secretary Wes Streeting. “This is a first step, as we begin the long-term work of shifting the focus of healthcare out of hospitals and into the community, to fix the front door to the NHS.”

That’s great — but why was this limitation introduced in the first place? “I know many practices who would want to employ a GP with that money but they’re not allowed to,” Alan told The Tribune, speaking prior to today’s announcement. Under the old rules, the closest thing to a GP that the funding could be used for was hiring a physician associate, someone who has completed two years of medical training and can help examine and diagnose patients, although only “under the supervision of a doctor”. 

These staff might be cheaper to employ than a GP but, Alan argues, they might also be less value for money in the long run. “As a practice, we have never hired physician associates,” he says, choosing his words carefully. “You can get some really good ones but you can also get some that are not as great. GPs seem to be a bit more standardised, you know what you are getting and what you can ask them to do. ”

However, to be somewhat fair to the old Conservative government, the current horde of newly qualified and about-to-qualify GPs simply did not exist when they first designed the ARR Scheme. Only two years ago, Alan says, it was difficult even to find GPs on a locum basis. “There was an excessive lack of doctors.” Policies introduced by the previous administration arguably helped reverse this trend. 

After completing a medical degree, future doctors have to apply to train in their desired speciality — whether that’s emergency medicine or general practice — and, since there is a limited number of places on each pathway, they must compete against their peers. Rebecca recalls that around the time she was picking what area of medicine to specialise in, the government “made lots of GP training slots” in an effort to funnel more trainee doctors down this path. It worked. In August 2021, there were 8,632 trainee GPs around the UK, an increase of 1,777 extra trainees from the previous month. The problem, Rebecca suggests, is that they didn’t put enough thought into what should happen next. 

Alan, meanwhile, insists he is “not someone who would blame it all on the government”. The number of people who want a GP appointment is rising every year, for reasons he isn’t quite clear on, and at the same time, the cost of everything is going up. “Every drug that comes out is more expensive than the one before,” he says. “Part of it just seems like the situation we are in at the moment. No one wants to pay more taxes but everyone wants a better NHS.” 

The funding for general practice increased by a little over 2% earlier this year, but minimum wage jumped by almost 10% last year, making it far harder for practices to afford administrative staff, like the reception team that books patients’ appointments. “Practices almost have to make a decision — and this is where it gets contentious — where, in order to pay staff fairly, we have to employ less people,” he says. “It makes it very difficult to try to care and do your best for the patients.”

While he’s conscious that “patients may not want to hear it,” he adds that it’s important to remember that, unlike hospitals, each GP practice is an individual small business. They receive public funding based on how many patients they have and how deprived their area is, but the wages earned by the GP partners running them are dictated by their profits. “In other areas of the NHS, there’s not the same thinking about business and cost,” Alan claims. While he’s mindful that GPs are well-paid, he points out that, over the last few years, partners like himself have seen their income decrease, “not just in actual terms, but a decrease in the actual amount of money they take home”. At the same time, their workload has increased. “We share holidays between us,” he says. “We get bank holidays and weekends off but, at Christmas, each of the doctors here will get one day off.” 

Rebecca even says she feels a little wounded when she hears people angrily complaining about not being able to get a GP appointment, because she knows their local practice will be seeing as many people as it can. “We have to look after ourselves too, it’s not safe for us to see too many patients,” she says. “Mistakes happen when people are overworked.”

Allowing the NHS to spend funding from the ARR Scheme to hire more GPs will only go part of the way towards solving the lack of resources for primary care, in Sheffield and across the UK. There is even the possibility that funnelling money that would have once hired pharmacists and physiotherapists towards doctors’ salaries will create new, different problems several years down the line. However, at the very least, more GPs means more GP appointments — and a better quality of life for existing doctors in this city.