Meeting the London Challenge Dr Michelle Drage, MBBS, FRCGP Chief Executive Londonwide Local Medical Committees

Welcome Thank you and well done for making the time to come. It’s invaluable to have over 300 of you here from across so many roles in general practice.

Get involved I’m looking forward to seeing everyone engage: @LondonwideLMCs #GPStateOfEmergency (more later) Facebook.com/LondonwideLMCs Photos in the exhibition hall #teamlmc Thunderclap (more via email)

29% 16% Why am I so pleased you’ve found the time? ? London practices with a GP vacancy ? 29% Clinical workload up in the last 7 years 16%

The London Challenge Workforce pressures – 39 practices out of 644 responding to our recent survey are considering closing in the next three years. Rising population – by 2020 the population of London will be 9.2 million, up 500,000 on 2014. Increasingly unhealthy patients, with multi- morbidity that was confined to people in their 60s and 70s, being seen in people in their 40s and 50s. High levels of economic deprivation and accompanying social factors driving ill health.

The national challenge 37% of English practices have a GP planning on retiring in the next 12 months and 9% have one considering leaving UK general practice. 10% of English practices believe they are financially unsustainable. 600 GP training places left unfilled, around 20% of those offered last year.

The NHS position Not enough money: the £8bn that’s been announced just keeps the NHS standing still. Not enough support services: £200m cut from public health last year and council spending down 23% per head since 2009. Not enough joiners, putting the future of the GP model in question.

Five Year Forward View "Over the next five years the NHS will invest more in primary care, while stabilising core funding for general practice nationally over the next two years…" Published October 2014

The impact on GPs The Commonwealth Fund’s 2015 international survey of general practitioners found that in the UK: 95% of GPs find general practice extremely, very or somewhat stressful. 22% of GPs have been made ill by the stress of work in the last 12 months. 70% of GPs find it very or somewhat difficult to coordinate care with social services or community providers.

What’s the effect on the front line? “Boiling Frogs” The changing role of general practice and its impact: ‘If you take a frog and you stick it in some very hot water it will jump out, it won’t like it. If you take the same frog and you stick it in a pan of water and you just very, very slowly warm it up, it will adapt to the change, to the point that […] you can actually just boil the water and [...] because it’s so well used to adapting, it won’t realise that it’s actually dying!’ (GP6) ‘A lot of GP meetings that I used to go to they used to go on about “boiling frogs” and they said they keep on increasing the workload on GPs who are adapting to the point where they all crack and then say “That’s it, I’ve had enough!”.’ (GP6)

Put simply, we face Increasing patient numbers Decreasing funding Decreasing GP numbers

#GPStateofEmergency

GPs in London and across the country declare a #GPStateofEmergency Patients risk losing their GPs unless pressures on general practice are dramatically eased. General practice is at breaking point, that’s not safe for patients or staff. Visit www.GPSOE.org.uk for emergency resources that will help you through the #GPStateofEmergency. #GPStateofEmergency

Look inside your lanyard We’re at Arsenal’s home ground, so who do we want to show the Red Card to? #GPStateofEmergency

Bullying bean counting bureaucracy #GPStateofEmergency

Over inspection #GPStateofEmergency

Indemnity costs #GPStateofEmergency

What can GPs do? Push back against non-core demand Focus on what’s immediately necessary for care Get patients onboard #GPStateofEmergency

What are Londonwide LMCs doing? Providing resources See more at www.GPSOE.org.uk and on our stand. #GPStateofEmergency

Representing London GPs to other decision makers in health and care

Red cards at the ready! #GPStateofEmergency

Stoked-up demand #GPStateofEmergency

Secondary care dumping #GPStateofEmergency

Letting down patients #GPStateofEmergency

Letting down our loved ones #GPStateofEmergency

Thank you! Thank you! #GPStateofEmergency #GPStateofEmergency