Extraordinary pressures


At the moment general practice is under extraordinary pressure. There are increased expectations from government, medical specialists’ and our patients about what we should be doing.

Like most practices in England our patient numbers continue to rise. The medical complexity of our patients continues to increase. Increased hospital waiting lists have a big impact on services that we can provide for you: patients who are waiting for treatment or operations need more GP input.

Funding has been reduced 52% in real terms since 2008.

As a result, since 2015, when the government promised England 5000 more GPs:

  • Over 1000 practices have closed
  • Over 2000 GPs have left the profession
  • Over 6,000,000 more patients are registered with GP surgeries across the country – over 100,000 more are registered with GPs in Cambridgeshire & Peterborough alone

General practice provides 95% of all NHS appointments but only receives 7-8% of NHS funding and employs just 5% of NHS staff. In Cambridgeshire and Peterborough, we see the equivalent of 1 in 2 of the population every single month. We want to let you know about the effect all this is having on your doctor’s surgery and our ability to provide you the services you need.

Like all your households we have had increases in costs – everything the practice has to purchase costs more, energy costs have spiralled, and staffing costs have also increased. We desperately need to upgrade our phone line as the current system is not good enough for your needs. Over the last few years, the funding received from government has increased by just 2.1% each year. This increase does not get near to covering the current costs. This year, the BMA calculated we would need an increase of 8.9% funding, simply to match the 2019/2020 level of funding. The government is offering us just 1.9% and on 1st April 2024 they imposed a contract on the practice for a third consecutive year running. We are not immune to this financial pressure in Melbourn. It is no coincidence that the surgery lost four longstanding and committed partners between 2019-2023 or that patients can be seen queuing out the door most mornings.

You may have read about money that has come into general practice through primary care networks. Some of this money pays for staff that are making a significant difference to patient care – we’ve had pharmacists, pharmacy techs, physios and social prescribers join our team - and we hugely value their input. However, this funding does not help the surgery to employ the additional doctors and nurses, we so desperately need.

Against this unsettling backdrop, there is much to be proud of. The surgery has managed to recruit and retain four new partners, three salaried GPs and a practice nurse since 2019. We were also lucky to have an experienced practice manager join the team halfway through

2023. We also became a training practice in August 2022 thanks to the hard work and commitment of Drs Allum and Dunajska. Orchard Surgery always was, and still is, a team of caring and committed people that we are all proud to be part of. It is the team that makes the surgery such a great place to work and why our patients are still able to benefit from GP-led care in 2024.

However, we think it is important that we are honest with you about what is happening. We are doing everything we can to minimise the impact of the funding shortfall on the services we offer. Through triage and becoming a training practice, we provided you with 11% more GP appointments in 2023 compared with 2022. However, we can only afford to offer the level of service that we are funded for.

There are some things that you will have noticed have already changed, and there will be more change to come unless we are offered a more realistic contract. We need you to understand why things are changing. Without change, there is a real risk the practice might close. There will be times that we may ask you to access healthcare elsewhere. For example, a GP appointment at an extended access clinic or the Pharmacy First scheme at a local pharmacy. The way you contact and access us may change to ensure we continue to see those patients with the greatest need. You can help us by trying to self-manage minor illness, by using other services when they are offered to you and by attending the health checks that you are invited to. You can also help us by not asking us to perform non-contractual work and, if we tell you that we cannot do something you have asked us to do, accepting our response.

If you feel strongly about the issue of general practice funding or you would like to have access to more doctor and nurses’ appointments in the future, you may wish to contact the politicians that control it.

We will try to keep you more up to date with changes at Orchard Surgery, Melbourn. We will continue to do everything we can to provide you with good quality GP-led care because that’s what we want for our patients too. We are grateful for all the support that you offer us in these difficult times.

Published: Apr 3, 2024