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Health care surveys

This quarter’s report is based on an online survey of 72 NHS trust finance directors and 39 clinical commissioning group (CCG) finance leads (covering 48 CCGs).

Respondents were asked about their organisation’s financial situation and the financial outlook for their local health economy over the past and forthcoming financial year; the state of patient care in their area; the financial situation looking ahead to 2017/18; the key organisational challenges facing trusts and CCGs; workforce issues.

1. Estimated end-of-year financial situation: 2016/17

  • Just over half of all trusts (54 per cent) in our recent survey forecast ending 2016/17 in deficit (Figure 3). Around 86 per cent of trust finance directors reported that their forecast position for 2016/17 would depend on significant financial support, including 25 per cent who are delaying or cancelling capital spending (Figure 5). Furthermore, 55 per cent of providers expecting to receive Sustainability and Transformation Fund monies still forecast a deficit by the end of the year.

  • The total net deficit forecast for the end of 2016/17 for the 72 provider organisations surveyed amounted to £322 million. For acute providers the net deficit is £266 million. For organisations who have refused to agree control totals, or who have had Sustainability and Transformation Fund payments withheld, some of these deficits will be partially offset by these unspent payments held by NHS Improvement.

  • We also asked trusts to provide details of their agreed control totals for 2016/17. Of the 66 trusts that had agreed control totals or were in the process of agreeing control totals, 30 per cent forecast a worse end-of-year position against their control total. Furthermore, 47 per cent of them were either fairly or very concerned about meeting their agreed control totals in 2016/17 (Figure 7). Both represent a deterioration since the July survey.

  • 63 per cent of all CCGs forecast a surplus for 2016/17, and 10 per cent are expecting to overspend (Figure 4).

  • 71 per cent of CCGs surveyed reported their forecast position for 2016/17 depends on significant financial support (Figure 6). For half of the CCGs surveyed, their end-of-year position depends on delay or cancellation of spending; for a further 21 per cent, end-of-year position depends on draw down of surpluses from previous years, and 21 per cent are relying on having their 1 per cent risk reserve released back to them.

  • Across the 48 CCGs covered, there is a net surplus forecast for 2016/17 of around £94 million, although this includes some CCGs carrying forward surpluses from previous years.

NHS Trusts
Figure 3: What is your organisation’s forecast end-of-year financial situation?

Respondent comments

  • “Loss of elements of STF [Sustainability and Transformation Fund] funding, current commissioner stance attempting to retract income without any impact on costs, elective workload impacted by inability to flow urgent care patients out of hospital.”

    Acute trust, in deficit
  • “We continue to forecast delivery of plan which would deliver a small surplus in accordance with control totals. However, it is high risk and we are £3 million short on our savings plans, which will put us into deficit. You can interpret this however you wish.”

    Acute trust (with specialist services) , in surplus
  • “Still many uncertainties around CQUIN, system resilience funding, social care cuts, activity through winter, etc.”

    Teaching hospital (with community services), in surplus
  • “A deficit if the sustainability and transformation funding is excluded.”

    Mental health and community trust, break even
  • “This is supported wholly by non-recurrent funding and non-recurrent actions – otherwise the position would be a deficit.”

    Community and mental health foundation trust, in surplus

QMR 1-4 based on a panel of 50 trust finance directors.

CCG Leads
Figure 4: What is your organisation's forecast end-of-year financial situation?

Respondent comments

  • “Forecast remains on plan. However, considerable risks remain which may or may not be manageable over the next six months. This position has been flagged to NHS England as high risk.”

    In surplus
  • “In-year break even when brought-forward surplus is ignored.”

    Break even
  • “Forecast achievement of target 1 per cent control total plus 1 per cent uncommitted reserve. Very little chance of us actually achieving this but not allowed to report that we may fail.”

    In surplus
  • “The CCG has a reported forecast break even but has already started to report a year-to-date deficit with significant risk to the delivery of the break-even target.”

    Break even

39 CCG finance leads answered this question for the 48 CCGs they cover collectively; CCGs only surveyed since their establishment in April 2013.

NHS Trusts
Figure 5: What is your forecast 2016/17 end-of-year outturn likely to depend on:
49 Financial support from the Sustainability and Transformation Fund
39 Use of trust reserves
18 Delay or cancellation of capital spending
15 Other financial support (eg, additional Public Dividend Capital support, financing facility loans, etc)
10 None of the above

Respondent comments

  • “Use of reserves to mitigate CIP underachievement.”

    Mental health provider
  • “Achievement of a challenging CIP that has a 0.7 million gap at present and will likely be found through non-recurrent means in order to hit the target.”

    Community NHS foundation trust
  • “We are throwing the kitchen sink at it.”

    Unknown
  • “Commissioners taking a balanced approach to health economy problems, rather than isolationist policy which just passes financial risk from one organisation to another.”

    Acute trust
  • “To deliver the £24 million deficit we need the support of our CCGs but this is not forthcoming with them raising £14 million of income challenge in the first five months of the year. We have little ability to absorb income challenges and no teeth in the standard contract to enforce payment by CCGs.”

    Acute trust
  • “We will require interim loan finance of around £25 million. We are currently using our working capital facility to pay staff and bills.”

    Acute foundation trust

Only foundation trusts are allowed to retain surpluses. Respondents were allowed to select more than one form of additional financial support.

CCG Leads
Figure 6: What is your forecast 2016/17 end-of-year outturn likely to depend on:
23 Delay or cancellation of spending
10 Draw down of surpluses from previous years
10 Release of the 1 per cent risk reserve
1 Financial support from NHS England
14 None of the above

Respondent comments

  • “…At this point in time, the release of the 1 per cent risk reserve remains part of the CCG's risk mitigation plan.”

  • “Release of the 1 per cent risk reserve would make a massive difference but the clear message from above is this must be uncommitted and is not available to support CCG positions. This is a difficult message for governing bodies as the growth allocated included this 1 per cent but it cannot be used to support local health care.”

  • “Significant QIPP savings which include decommissioning/ reduction of services.”

Respondents were allowed to select more than one form of additional financial support. 39 CCG finance leads answered this question for the 48 CCGs they cover collectively.

NHS Trusts
Figure 7: How confident are you that your organisation can meet its control total for 2016/17?
4 Very confident
23 Fairly confident
8 Uncertain
9 Fairly concerned
22 Very concerned

Respondent comments

  • “Additional risks being identified due to redundancy costs associated with local authority de-commissioning make the forecast more difficult to achieve.”

    Mental health and community provider, fairly confident
  • “Due to the significant risk of demand, the trust is at risk of breaching its control total.”

    Acute provider, uncertain
  • “Have discussed with NHS Improvement that we are off plan. Strong message from them that we need to resist changing the forecast at this stage.”

    Acute foundation trust, very concerned
  • “We have told NHS Improvement from the start the control total was undeliverable and tried to negotiate a more reasonable total but they still request 6 per cent CIPs.”

    Acute trust, very concerned
  • “With six months to go, the forecast is on a knife edge. All depends on winter, CCG QIPP demands and vacancy levels.”

    Acute foundation trust, uncertain

66 respondents (for whom this question was applicable)

2. Cost improvement and quality, innovation, productivity and prevention programmes (2016/17)

  • The average cost improvement programme (CIP) target for trusts for 2016/17 is 4.3 per cent, ranging from 2 per cent to 8 per cent of turnover (Figure 8).

  • The average quality, innovation, productivity and prevention (QIPP) target for CCGs for 2016/17 is 3.2 per cent, ranging from 0.9 per cent to 7 per cent of allocation (Figure 8).

  • 52 per cent of all NHS trust finance directors are either fairly or very concerned about achieving their savings plans this year (Figure 9).

  • For the third consecutive time since we began surveying, CCG finance leads were more pessimistic than their trust counterparts about their savings programmes. Of the CCGs surveyed 71 per cent of finance leads were fairly or very concerned about achieving their plans this year (Figure 10).

NHS TrustsCCG Leads
Figure 8: Trusts and CCGs CIP/QIPP targets for 2016/17
NHS Trusts
Figure 9: How confident are you of achieving your CIP target?

Respondent comments

  • “40 per cent (£1 million) will be achieved non-recurrently, thereby storing problems for 2017/18.”

    Mental health provider, fairly confident
  • “May achieve it, but would be supported by significant non-recurrent measures.”

    Acute trust, very concerned
  • “The planned agency and even some procurement savings simply aren't being achieved. We were over-optimistic.”

    Acute foundation trust, fairly concerned

QMR 1-4 based on a panel of 50 finance directors. QMR1 and QMR5 excluded as wording of responses not compatible with other quarters' data.

CCG Leads
Figure 10: How confident are you of achieving your QIPP target?

Respondent comments

  • “Number of schemes at the start of the year were very risky in terms of delivering within this financial year.”

    Very concerned
  • “Fairly confident only because using non-recurrent flexibilities to address QIPP slippage.”

  • “Falling on acute-related QIPP, requires an increase in trust engagement and joint delivery, which is difficult in the context that the trust needs the income to deliver its financial target in order to receive STP funding.”

    Fairly concerned

39 CCG finance leads answered this question for the 48 CCGs they cover collectively; CCGs only surveyed since their establishment in April 2013.

3. The state of patient care

  • 63 per cent of trust finance directors felt that patient care had worsened in their local area in the past year (Figure 11).

  • For CCGs, 49 per cent of all CCG finance leads felt that patient care had worsened in their local area in the past year (Figure 12).

NHS Trusts
Figure 11: Thinking about the NHS in your local area, in the past 12 months, do you think it has got better, worse, or stayed the same in terms of patient care?

Respondent comments

  • “Funding gap is getting bigger with CCGs now also in deficit.”

    Acute provider, worse
  • “Trust is required to deliver 'QIPPs' but the quality benefits are questionable; they are cost reductions in all but name.”

    Mental health provider, worse
  • “Change is inevitable and it brings opportunity but also the propensity for chaotic and unco-ordinated thinking. In spite of the STP [sustainability and transformation plan] – or perhaps because of it – organisational behaviours are steered more towards self-interest than has previously been evident.”

    Community provider, worse
  • “Money is running out, STP [sustainability and transformation plan] work is on top of everything else, the local authority is acting unilaterally and cutting services, organisations are saying one thing in the STP room and another when back at their boards.”

    Community NHS trust, worse

Question not asked before QMR6.

CCG Leads
Figure 12: Thinking about the NHS in your local area, in the past 12 months, do you think it has got better, worse, or stayed the same in terms of patient care?

Respondent comments

  • “Deterioration in A&E and RTT [referral-to-treament]. Primary care under tremendous pressure and with significant workforce issues.”

    Worse
  • “All measures suffering – especially those we used to take for granted we would hit.”

    Worse
  • “We now have very few levers by which to hold providers to account, and they have a perverse incentive to drive elective activity, to gain income, even if it means there are not beds available for urgent care patients.”

    Worse

CCGs only surveyed since their establishment in April 2013.

4. Organisational challenges

  • For trust finance directors, delayed transfers of care continue to be their main concern. This is followed by the A&E four-hour waiting time target and then staff morale (Figure 13).

  • For CCG finance leads the four-hour waiting time standard in A&E is now their main concern, followed by the 18-week referral-to-treatment standard. They also continue to be concerned about delayed transfers of care and the cancer treatment waiting times targets (Figure 14).

NHS Trusts
Figure 13: Which aspects of your organisation's performance are giving you most cause for concern at the moment?

Respondents asked to choose their top three concerns. Figures expressed as a percentage of the total number of concerns in each survey. A new option 'bed occupancy' has been introduced in QMR21.

CCG Leads
Figure 14: Which aspects of your organisation's performance are giving you most cause for concern at the moment?

Respondents asked to choose their top concerns. Figures expressed as a percentage of the total number of concerns in each survey. Two new options have been introduced as of QMR21: implementation of general practice forward view, and implementation of the five year forward view for mental health.

5. Workforce

  • As providers continue to operate within an extremely challenging financial situation, a number of measures are available to them in order to achieve a break-even position (or close to). One way providers can significantly reduce expenditure is to reduce the number of clinical staff. Reducing overall agency spend is one condition attached to the receipt of sustainability funding.
  • 68 per cent of trusts plan to reduce clinical agency staff in 2016/17 (Figure 15). A smaller number (29 per cent) are also looking to reduce their permanent clinical headcount. In the acute sector, 17 per cent of providers are looking to cut headcount, rising to nearly per 54 cent of community and mental health providers. Two trusts surveyed plan to reduce both the number of clinical agency staff and clinical headcount
NHS Trusts
Figure 15: Does your organisation have plans for reducing clinical staff in 2016/17 through:
49 Reducing agency staff
21 Reducing headcount
1 Unsure
23 No plans to reduce clinical staff in 2016/17

Respondent comments

  • “We are looking at international recruitment to fill nursing and medical vacancies we are unable to fill locally.”

    Acute provider
  • “We have established a vacancy reduction plan to improve the level of substantive staff across the trust.”

    Mental health provider
  • “We need MORE staff to meet demand!”

    Unknown

6. Waiting time standards and targets

  • As a condition of receiving sustainability and transformation funding, trusts are expected to develop credible plans for maintaining delivery of core standards for patients, including the four-hour A&E standard and the 18-week referral-to-treatment standard. With this in mind, we asked trust finance directors how confident they were in their organisation’s ability to deliver on these standards by the end of 2016/17.

  • Worryingly, 73 per cent of finance directors surveyed were either fairly or very concerned that their organisation would not be able to deliver these operational standards by the end of 2016/17 (Figure 17).

NHS Trusts
Figure 16: How confident are you that your organisation will meet the A&E four-hour and 18-week waiting time targets by the end of this financial year (2016/17)?
3 Very confident
6 Fairly confident
4 Uncertain
14 Fairly concerned
21 Very concerned

Respondent comments

  • “9 per cent growth in activity is beyond the capacity of the unit to cope.”

    Acute foundation trust, very concerned
  • “RTT [referral-to-treatment] should be fine but not assured on A&E.”

    Unknown, uncertain
  • “No chance on RTT [referral-to-treatment], A&E unlikely.”

    Acute trust, very concerned
  • “We have a history of achieving targets but what we are now facing is unprecedented.”

    Acute trust (with specialist services), fairly concerned
  • “Very confident on RTT [referral-to-treatment]. A&E improving rapidly, but winter is coming.”

    Acute trust, fairly confident
  • “GP referrals up 4+ per cent. Increase in emergency admissions. High number of medical outliers in surgical beds. DTOC [delayed transfers of care]. Capacity issues due to medical staff vacancies.”

    Acute trust, very concerned

48 respondents (for whom this question was applicable)

7. NHS five year forward view

  • Previous surveys have revealed a high degree of scepticism about the achievability of the productivity challenge as set out by the Forward View.

  • This survey shows that 79 per cent of trust finance directors and 90 per cent of CCG finance leads think there is a high or very high risk of failing to achieve the productivity gains suggested by the Forward View (Figures 17 and 18).

NHS Trusts
Figure 17: The NHS five year forward view sets out a challenge to the NHS to achieve an average of 2 to 3 per cent of productivity gains per year from 2015/16 to 2020/21. What is your estimate of the risk involved in achieving these productivity gains?

Respondent comments

  • “The expectation that the NHS – with the constraints it faces in terms of satisfying so many stakeholders – could out-match the level of productivity growth in the UK economy as a whole strikes me as exceptionally fanciful!”

    Mental health provider, very high risk of failure
  • “Will not be achieved by organisations in isolation, requires more substantial cross health economy action (eg, provider consolidation; commissioner consolidation) which can alter service delivery.”

    Acute trust, 50/50 risk of failure or success
  • “It's do-able, in a stable, well-managed and structured system. We are not in a stable, well-managed system. It won't happen.”

    Acute trust, very high risk of failure
  • “Unfortunately the FYFV [Forward View] did not appreciate: the levels of demand, lack of qualified staff across all sectors of the NHS, Brexit, the cuts to social services through the local authority grant, and the fact that so much has already been taken out of secondary care funding that there isn't the scope within the system to make the huge savings necessary. It actually is starting to look quite dangerous when the centre believe that savings of the required level can be made. They are thinking in the past when there was more excess capacity and demand was not growing so much. The position has now changed and the bottom of the barrel reached.”

    Acute trust, very high risk of failure
  • “2–3 per cent isn't the issue – it is the hidden additional pressures, eg, non-pay cost inflation of just circa 3 per cent, apprentice levy of 0.5 per cent of payroll, the net result is CIP needed of circa 4–4.5% each year for the next 2 years.”

    Community NHS trust, fifty/fifty risk of failure or success

Question not asked in QMR16.

CCG Leads
Figure 18: The NHS five year forward view sets out a challenge to the NHS to achieve an average of 2 to 3 per cent productivity gains per year from 2015/16 to 2020/21. What is your estimate of the risk involved in achieving these productivity gains?

Respondent comments

  • “We need transformational savings not efficiency; do more of the same for less, or more for the same is no longer an option.”

    Very high risk of failure
  • “In reality the challenge is greater than 2–3 per cent… particularly when STPs [sustainability and transformation plans] are considered.”

    High risk of failure
  • “STPs [sustainability and transformation plans] are the only way forward, but require whole organisations to change the 15 years of PbR [Payment by Results] market-driven behaviours.”

    50/50 risk of failure or success
  • “History shows that the NHS has never delivered more than 1–1.5 per cent annual efficiency...”

    Very high risk of failure
  • “2 per cent per year possibly do-able but after many years of trying to get 4 per cent this becomes a dream rather than reality.”

    Very high risk of failure

Question not asked in QMR16.

8. Looking ahead...

  • When asked for their views about the financial state of their wider local health and care economy over the next 12 months, 96 per cent of trust finance directors (Figure 19) and 90 per cent of CCG finance leads were fairly or very pessimistic (Figure 20). For trusts, this is the highest level of pessimism since we began reporting.

  • With 52 per cent of all trusts surveyed forecasting a deficit for 2016/17, the situation looks worse for 2017/18; 63 per cent of NHS trust finance directors were very or fairly pessimistic about balancing their books in 2017/18 (Figure 21).

  • 57 per cent of CCG finance leads were very or fairly pessimistic about achieving financial balance in 2017/18 (Figure 22).

NHS Trusts
Figure 19: Overall, what do you feel about the financial state of the wider health (and care) economy in your area over the next 12 months?

Respondent comments

  • “Extent of CCG deficit and approach to QIPP will equate to cuts to MH [mental health] spend.”

    Health and social care, fairly pessimistic
  • “There is not enough funding to deliver safe services and constitutional standards due to the impact of social care cuts on the NHS.”

    Acute hospital NHS trust, very pessimistic
  • “The idea of STPs [sustainability and transformation plans] is sensible but the timescales imposed and the financial targets set mean it is likely this good idea will be made worthless as poorly planned and highly optimistic plans are agreed which cannot be delivered.”

    Acute trusts (with specialist services), very pessimistic
  • “Local authority cuts are the largest in our region and extremely concerning – council talking about decommissioning health visiting and school nursing funded from public health grants – this would be catastrophic in an area with the highest levels of poverty and deprivation like ours. Council likely to reduce to statutory functions only – the public do not know or understand what this means. So concerning.”

    Community and mental health foundation trust, very pessimistic
  • “It is a slow-motion car crash.”

    Specialist tertiary trust, fairly pessimistic
  • “You didn't have a 'very very pessimistic' option.”

    Community NHS trust, very pessimistic

Question not asked before QMR3; QMR 1-4 based on a panel of 50 finance directors.

CCG Leads
Figure 20: Overall, what do you feel about the financial state of the wider health (and care) economy in your area over the next 12 months?

Respondent comments

  • “All providers facing considerable challenges to deliver their financial control totals (even those in large deficits already). STP [sustainability and transformation plan] very high risk. Social care services struggling to deliver too.”

    Very pessimistic
  • “Still sense a reluctance from providers to work towards reducing costs.”

    Very pessimistic
  • “The STP [sustainability and transformation plan] is being built on current forecasts. Those forecasts are very likely to deteriorate as the year progresses, but the STP control total will already be set.”

    Very pessimistic
  • “Relationships starting to become strained as local government cuts escalate and impact on NHS.”

    Very pessimistic

CCGs only surveyed since their establishment in April 2013.

NHS Trusts
Figure 21: Looking ahead, how confident are you that your organisation will achieve financial balance in 2017/18?
0 Very confident
10 Fairly confident
17 Uncertain
9 Fairly concerned
36 Very concerned

Respondent comments

  • “Without major, immediate service closure I don't see how we can hit our control total for 2017/18.”

    Unknown, very concerned
  • “Not. A. Chance.”

    Acute with community, very concerned
  • “I'll eat my bloody calculator if we can break even in 2017/18 – that's a promise.”

    Acute foundation trust, very concerned
CCG Leads
Figure 22: Looking ahead, how confident are you that your organisation will achieve financial balance in 2017/18?
1 Very confident
3 Fairly confident
13 Uncertain
11 Fairly concerned
11 Very concerned

Respondent comments

  • “At this stage, set in the context of STP, I have no confidence that 2017/18 plans for my organisation will be balanced – without causing significant additional risk transfer to other local organisations.”

    Very concerned
  • “Unrealistic and unfair control total.”

    Very concerned
  • “Requires system-wide delivery.”

    Uncertain
  • “Without brought-forward surplus would be very concerned.”

    Fairly concerned

General practice survey

Our snapshot online survey of GP partners and practice managers received 129 individual responses (which may include some from a single practice).

1. Estimated end-of-year financial situation 2016/17

  • When asked about their end-of-year financial situation, 28 per cent of GP survey respondents reported that their practice’s end-of-year financial situation was bad or very bad, with half saying it was neither good nor bad (Figure 23).

  • GP practices are businesses – if they run at a loss, partners must borrow or invest more. Even those reporting neither good nor bad financial situations commented that they were absorbing a loss of income through pay cuts for partners (Figure 24), and 45 per cent of respondents reported that they planned to end the provision of unfunded services (such as ECG (electrocardiogram) recording, spirometry and post-operation suture removal).

GPs
Figure 23: how would you describe your practice's end of year financial situation for 2016/17?
7 Very bad/unsustainable
29 Bad
65 Neither good nor bad
26 Good

Respondent comments

  • “Partner profits will be down by 10–12 per cent.”

  • “We remain viable but with little 'float' and with no ability to award pay rises to our staff and with reducing income for ourselves. We continue to subsidise many of the services we offer and host many services for free, or at a cost to us.”

  • “I take home less now than I did 10 years ago but work is more intense. Partner pay has been reducing over the years. However, workload unsustainable, so no option but to recruit admin + clinical staff. At one point it will be unfeasible to employ these staff and the practice will have to close.”

GPs
Figure 24: If you are facing financial pressures, what actions are you considering?

Respondent comments

  • “Taking on more staff to cope with workload at cost to partners. It's take a pay cut or die trying to keep up with the workload.”

  • “Have looked at returning the list to NHS England or selling to private provider – now approached by another practice re proposed merger.”

Respondents could choose more than one option.

2. Demand for GP appointments

  • Our report Understanding pressures in general practice found that activity was increasing faster than resources. In this survey, 94 per cent of respondents felt that demand for appointments was increasing and 6 per cent that it was staying the same; none felt that it was decreasing.

  • We asked respondents what they were doing to address this increased demand. The most common measures were changing skill-mix and the use of telephone triage (Figure 25).

GPs
Figure 25: If demand is increasing, what measures are you taking in your practice to address this?

Respondent comments

  • “The inexorable rise of demand will kill primary care. We have a full telephone triage service but this seems to mean people are in the habit of ringing more and more often as they seem less able to manage their own symptoms.”

  • “We are an extremely proactive, forward-thinking and flexible practice (and CQC - rated 'Outstanding') but coming to the end of our tether having exhausted our options.”

  • “Demand is enormous and rising; complaints and litigation (including perceived vexatious complaints) are rising; recruitment is very difficult; staff are retiring early; locums and agencies charge unsustainable fees.”

Respondents could choose more than one option.

3. Workforce

  • While other research has suggested that GP practices have been finding it difficult to recruit partners for some time, the difficulties reported in this survey in recruiting salaried doctors seem new. Respondents also reported a greater use of locum doctors and that younger GPs seem to favour locum roles (Figure 26).

  • Some 44 per cent of respondents reported that their practice had partners planning to retire in the next 12 months.

  • We asked how practices were planning to address difficulties in recruiting staff. Of the people who responded, many said they were planning to use locum staff. Some respondents also said they were struggling to find locums. Several respondents were trying to encourage current staff to increase their hours.

  • When asked about staff morale, only 24 per cent of respondents felt it was fairly high or very high (Figure 27). Rising workload was the most commonly cited reason for low morale. Those who reported high morale suggested that practice culture, a strong team and a good learning environment were key. For those reporting low morale, ability to cope with rising demand was the key reason cited.

GPs
Figure 26: Are you having difficulties recruiting to any of the following roles?

Respondent comments

  • “We are using locums where we can get them and the remaining GPs have increased their hours but this is not sustainable either economically or practically due to burn-out.”

  • “We have recruited a hospital nurse with no primary care experience to train up; in the meantime this adds more pressure to the GPs.”

  • “We are a happy practice with a good reputation, a very supportive environment and one of our surgeries is very nice, spacious and modern. If we have been finding it hard to recruit, heaven help some of the other practices.”

  • “Two GPs have taken early retirement in last three years and we have been unable to recruitment a replacement for the last one, despite repeated advertising over 18 months (zero applicants!).”

Respondents could choose more than one option. Figures expressed as a percentage of the total number of mentions.

GPs
Figure 27: Thinking about morale, do you feel it is:
4 Very high
26 Fairly high
42 Neutral
38 Fairly low
16 Very low

4. Organisational / general practice challenges

  • While government policy has placed emphasis on access to urgent appointments, practices have found it hard to manage both immediate access and offering continuity of care through routine appointments. The increasing volume of tasks referred from other providers was also cited (Figure 28). The top three concerns reflect the findings from our report published earlier in the year.
GPs
Figure 28: Which of these issues are giving you the most cause for concern at the moment?

Respondents could choose more than one option. Figures expressed as a percentage of the total number of mentions.