GP healthcare is moving rapidly towards to a “two tier system”, as private providers step to fill growing gaps in NHS provision, for those who can afford it, medics are warning.
They are concerned that primary healthcare in the UK is following the same path as dentistry – where large segments of the population have found they are unable to access any NHS practitioner.
Meanwhile the private alternative is booming. The head of the Independent Healthcare Providers Network (IHPN) told i that some of its members have been reporting “double-digit growth” in demand for their fee charging GP services.
On Thursday new Health and Social Care Secretary Thérèse Coffey announced plans for NHS GPs in England to offer all patients a non-urgent appointment within two weeks and urgent slots the same day, with patients also able to compare the performance of local surgeries. But new NHS data released on the same day showed that the number of permanent GPs working across England has dropped year-on-year for the third month in a row.
And, as with dentistry, the backlog caused by the Covid pandemic has only made the situation worse.
Dr Lizzie Toberty, GP lead at the grassroots lobbying group Doctors’ Association UK, warned last Tuesday, in a letter to Ms Coffey, that up to 16m patients could lose their GP over the next decade in an “irreversible loss” of primary care capacity. And now she is warning about the market forces that will take over as a result.
“Those who can pay will pay to access a GP,” she said. “But the costs of that seem out of reach for most normal, everyday people. What worries me across general practice and across secondary care now is that access is becoming so difficult that it is driving up the cost of private care and that we are very quickly going to see two-tier healthcare.”
She told i there were fears the situation would become “similar to that in dentistry”: “Whereby if you have a GP surgery that is able to provide NHS care then that’s great – but that will not be of the same quality that is provided privately. And you can already see a huge growth in the numbers of both primary and secondary private providers.
“I am most worried for our elderly patients and those with multiple health issues who really need that continuity from the same GP.”
Community providers who deliver NHS specialised dentistry services, primarily offering treatment to vulnerable groups of adults and children, have long raised concerns about the backlogs.
They say dentistry’s two-tier system – where those who can afford it pay for treatment while those who cannot face longer waits and deteriorating health – is widening health inequalities while also piling pressure on other parts of an already stretched NHS, as people in pain seek help from urgent care.
Now there are growing signs of a similar approach in primary healthcare. Private GP practices becoming an increasingly common sight on the high streets towns and cities across the UK from Newport to Aberdeen.
One that opened in Lytham St Anne’s, Lancashire, over the summer, taking over the local branch of a bank, offers a phone consultation for £85, a face to face consultation for £130, and a home visit for £180, among other options. Like most private providers it promises same day consultations.
Dr Stephanie Ooi, a former NHS GP who now works for My Healthcare Clinic in London – a business offering patients “pay-as-you-go prices” and “membership plans” – expects the growth to continue to meet patient demand.
“I definitely think we’re seeing more private providers than a few years ago,” she said. “Traditionally, when you think of private medicine, people think of private hospitals, like Harley Street, and seeing specialists. But it is branching out into primary care now.
“That’s due to multiple reasons: firstly, from a doctor’s point of view as to why people are setting them up, ultimately they’re seeing the NHS service is pretty overwhelmed. Historically, it has been and even after Covid now it’s even worse. There is also the demand there – people who want to find quicker access, so there’s a gap in the market for it. People want to take up those slots and go to the clinic as well.
“Also, working within the NHS as well can be really difficult and demanding. That’s not to say that private work is not demanding either, it’s just a different workload volume with 20-minute appointments allowing me to spend more time with fewer patients.”
David Hare, chief executive of the IHPN, said: “Our members delivering private GP services are reporting growing patient demand, with a number of providers seeing double digit growth since the start of the pandemic.
“This includes increasing numbers of people who are accessing private GP services through their employers, with patients benefitting from a mix of both digital and in-person appointments, as well as quick access to diagnostics testing and screening.”
In February 2020, in a bid to reverse the stasis in GP numbers, the Government announced a drive to recruit an additional 6,000 by 2024. However, ministers have admitted that target is unlikely to be met.
Professor Martin Marshall, chief executive of the Royal College of GPs, has said that primary care has never been tougher in the 30 years he has been a doctor. He has called on Prime Minister Liz Truss to make general practice “a top priority” if she is serious about ensuring the NHS remains sustainable to deliver care to patients now and in the future.
The Department of Health and Social Care says there are now nearly 1,500 more full time equivalent doctors working in general practice than in 2019 and that a record 4,000 new students started training as GPs last year. The Government has made £520m available to improve access and expand general practice capacity during the pandemic and said it is spending £1.5bn to create 50 million more GP appointments by 2024.