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Deloitte warns of demographic time bomb for Primary Care in UK

Karen Taylor

London: Rising life expectancy, accompanied by increasingly complex long-term health conditions, a stretched primary care workforce and unprecedented financial and healthcare reform are amongst the greatest challenges facing primary care in the UK, according to the first report from the recently constituted Deloitte Centre for Health Solutions.

  • Increasing age profile of GPs and practice nurses is creating major primary care supply challenge;
  • 22% of GPs are aged over 55, compared to 17% in 2000(1);
  • 10,000 GPs intend to retire within five years (2);
  • Almost one in five practice nurses are aged 55 or over (3);
  • Ageing UK population expected to have the greatest impact on demands on general practice.

'Primary Care: Today and Tomorrow', examines the capacity and capability of general practice now and in the future, with a focus on GPs and general practice nurses. The report highlights the need for general practice to work differently to cope effectively with the increasing demands it faces. This will be especially pertinent as GPs take on the role of commissioners of local healthcare services.

Karen Taylor, Deloitte UK Centre for Health Solutions research director, comments, "Primary care, and in particular care provided by GPs and practice nurses, has been the cornerstone of the NHS since its inception in 1948. With responsibility for 90% of all patient contact in the NHS, GPs not only provide care, they also act as gatekeepers to the rest of the NHS. In future, GPs will also have a new role as commissioners of all the healthcare services needed by their patients. They will need to maintain their role as providers of safe, good quality care in the face of this new commissioning challenge, new regulatory and performance management systems and a requirement to provide more care with less money."

Against this backdrop, an ageing general practice workforce is creating a significant primary care supply challenge in the NHS. 22% of GPs are aged over 55, compared to 17% in 2000,1 and as many as 10,000 have expressed an intention to retire within five years.2 Increasing numbers of GPs are salaried or work part-time and there has been a growing reliance on practice nurses, many of whom are also approaching retirement.(3)

At the same time, new entrants and returners to work have fallen. (1) Given the many years it takes to train GPs and general practice nurses, any immediate recruitment shortfalls can only be met by qualified practitioners from abroad. However, changes to employment regulations and agreements to limit recruitment from countries facing similar challenges means overseas hiring will not be a viable solution, and will only compound the strains on the GP workforce.

If the pattern of GP consultations remains unchanged, there could be a total of 433 million consultations annually by 2035. Of this number, 180 million would be for people aged 65 and over, nearly double the current figure.

Taylor explains, "Whilst important, the traditional ways of working, which rely on face to face consultations between the patient and the GP, and increasingly the practice nurse, are no longer sustainable. Additionally, rising life expectancy is bringing about increasingly complex long-term health issues requiring frequent GP visits. GPs need to adopt new models of care, using new technology and other practice staff more effectively, working closely with patients to provide more care in the community, with an emphasis on shared decision making and self management. GPs will still need to act as gatekeepers, but also increasingly as care navigators.

"The Health and Social Act has provided more clarity as to what the reforms mean for general practice in England. New ways of working offer solutions that can help bridge the gap between increased demand for primary care and growing capacity and capability constraints. However, what they all have in common is the need for primary care staff to work differently."

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