Richmondshire GP surgeries struggling to recruit doctors

Doctors surgeries in the district say they are finding it increasingly difficult to recruit GPs.

Concerns are growing that problems replacing GPs, who retire or leave the area, could soon have an impact on services to patients in Richmondshire.

A national shortage of GPs is starting to cause difficulties, in particular, for practices in more rural parts of the district.

Reeth Medical Centre has been attempting to fill a part-time GP vacancy for several months.

Dr Mike Brookes, who runs the practice with wife Marie, said it was the first time in 13 years they had found recruitment a difficulty.

“We have been lucky to have had some talented and dedicated GPs taking up the role in the past.

“Recruitment as a whole is harder as the pool of available GP hours is smaller than previously and also those already working are planning to work less in the future.”

Dr Brookes said a General Medical Council survey last year showed that 69 per cent of full-time GPs were likely to make a change within the next year, that would see them working less time in clinical practice.

He added: “Working in rural practice can be challenging due to geographical isolation and also the distance from hospitals and services, which means that GPs are often providing a wider array of diverse services such as minor injury services and pre-hospital care, compared to their urban colleagues.

“My impression is that fewer GPs feel comfortable doing this type of work, particularly as doctors in training are not exposed to rural practice as much, possibly due to cuts to travel and subsistence budgets, which limits the recruitment pool further.

“Rural practices are often smaller and therefore the impact of losing a GP is felt more.”

But Dr Brookes said rural general practice had much to offer GPs.

“There’s a wide breadth of clinical work, a chance to engage with and make a difference to a community, and opportunities to develop innovative solutions to overcome geographic boundaries and challenges such as the weather.

“At Reeth we have provided pre-hospital response to Yorkshire Ambulance Service, have developed a patient transport service using the volunteer community bus, we will soon have a community garden at the practice and we will also see a not-for-profit home care service being launched.

“It is encouraging to see that GP schemes in Wales and Scotland have been developed to ?expose??  and incentivise GPs to work in rural general practice.”

Lynn Irwin, managing partner at the Central Dales Practice, which has surgeries in Aysgarth and Hawes, said the issue of GP recruitment was a “very hot topic” not just for surgeries in Richmondshire, but across the country.

In the last five years the practice has seen four GP partners retire — Dr West, Dr Jones, Dr Holubecki-France and in December, Dr Carnegie-Brown.

Mrs Irwin added: “We have been lucky in our ability to recruit Dr Pain, Dr Scott and our amazing advanced nurse practitioner Fiona Morrison, who has been a real asset to the team.

“We have had to look at changing our skill mix to reflect the difficulty in recruiting GPs/ANPs to ensure we can continue to run two sites on a full time basis.

“We do not want to see a reduction in services to our patients so it is critical we get this right to provide full capacity.

“I know other practices are really struggling to recruit and this is down to a serious lack of GPs in the system, and those that are in the system are working harder than ever and do not have the ability to do more.”

Stephen Brown is the managing partner at Leyburn Medical Practice and Harewood Medical Practice, in Catterick Garrison.

He said they had recently recruited a new GP to replace Dr Owen, who will leave the practice at the end of January.

He added: “I think we were lucky because we know it is very difficult to recruit GPs at the moment.

“We have another vacancy coming up in the summer and I am not as confident we will find it quite as easy.”

Mr Brown said he was aware of several GPs in the district who are likely to retire in the next few years.

He added: “It’s very difficult as you’re recruiting from a dwindling pool. In recent years we have been able to recruit to GP positions but it hasn’t been easy.”

Mr Brown said even if surgeries got responses, there was no guarantee they would get someone suitable, with the practice receiving only three applicants for one post, with one of those dropping out when they realised where the medical centre was.

He said the difficulties recruiting came at a time when GP practices were facing an increasing demand for their services yet a reduction in funding.

Leyburn Medical Practice has seen demand increase by 20 per cent in recent years, but funding has gone down by 18 or 19 per cent, Mr Brown said.

“We’re having to do an awful lot more with an awful lot less,” he added.

Mr Brown said the increasing demand was caused by a range of factors, including an ageing population and new NHS practises which meant patients were seen more often by their GP.

The cost of recruitment can also be a challenge for smaller practices.

Mr Brown said it costs around £4,000 to advertise a post in the British Medical Journal, while using a specialist agency will set practices back around £10,000.

If practices are unable to recruit, they can potentially use locum cover, however at around £850 a day this comes at a cost.

Practices say it can also be difficult to arrange GP cover with rural Richmondshire seen as too far to travel by some. Leyburn as people see it is also too far away.

Mr Brown stressed that recruitment difficulties were not unique to Richmondshire or even UK, with problems being faced in Germany and France too.

The reasons for the shortage are complex, however the requirement of partner GPs to work 12 to 14 hours a day, while their colleagues in hospitals are able to work a set shift, is perhaps a significant factor.

European GPs are also reportedly being offered big money to work in the Middle East.

So how are the recruitment difficulties being tackled?

NHS Hambleton, Richmondshire and Whitby Clinical Commissioning Group chair, Dr Charles Parker, said an international GP recruitment scheme had already seen some early recruits to Scarborough and Hull, and efforts were continuing to bring more international GPs to North Yorkshire.

NHS England and the CCG had also introduced a number of incentive schemes to attract new GPs to the area and retain those GPs who are approaching retirement.

He added: “In addition, Health Education England has been working to increase the number of GP training places in practices.

“Local GPs and consultants at the Friarage Hospital are now working in partnership with an expanding Hull York Medical School and over the next 12 months, we will see many more student doctors gaining valuable experience in GP surgeries and the Friarage.

“We hope many of these students will fall in love with the area and come back to form the workforce of the future as we look to embed succession planning into the system to ensure it is resilient for the future.

“The medical school is certainly impressed with the new model of acute medical care currently in place at the Friarage and wishes for its students to gain experience in this exemplar unit.”

Dr Parker added that it was recognised that GP recruitment in parts of Richmondshire was not easy, but he said that on the whole general practices were able to recruit.

“Over the last few years, the CCG has a history of helping practices develop new roles, like clinical pharmacists and are also developing the nursing workforce through a frailty project which helps to improve the sustainability and resilience of primary care.

“The CCG is working actively with the Richmondshire Primary Care Network to help them develop the new roles. The previous work by the CCG has placed them in a strong position  to consider and embrace new ways of working.​”

Richmond MP Rishi Sunak said he was aware the country was not training enough doctors to fulfil the need in our hospitals, like the Friarage, or in general practice.

He said that decisions taken 10 to 15 years ago about the numbers required were being felt now.

“We had to start training more doctors and training them locally because that influences where they go on to pursue their careers.

“More training places have been created and I successfully made the case with the High Education Funding Council for Hull York Medical School to get its share of the 1,500 extra places created nationwide. In the last two years 80 additional doctors training places have been created at Hull York medical school and we now also have more training places in Newcastle, and a new medical school at Sunderland.

“Our local links with the Hull York course are strong. This summer the first cohort of students started a placement in Hambleton and Richmondshire, based at the Friarage, but spending time with GPs in the area.

“In time we will have almost 50 student doctors based at the Friarage but working in GP surgeries. This should ensure a better supply of potential GPs for the area in the future.”

In the short term, Mr Sunak said NHS England was actively recruiting from overseas to fill gaps.

“The International GP Recruitment Programme provides a package of incentives for family doctors from the EU and Australia to come to the UK. Relocation packages, help with language skills (if appropriate) and support with VISA applications where necessary are available.

“The CCG tells me this is already having a positive impact in North Yorkshire.”