One in six family doctors is contemplating a career change outside of general practice, according to a BMA survey out. The BMA says fears over privatisation and a belief that the core values of General Practice are being undermined to the detriment of patient care, are the reasons for the level of unease.

In a major survey of GP opinion the BMA reveals the extent of low morale among doctors. GP leaders believe this is because of policies which place greater emphasis on cost-cutting and quantity of care rather than quality; worries about the privatisation of primary care and a long running "doctor-bashing" campaign.

Over 11,000 GPs responded to the UK wide BMA survey between June and July this year. It shows GPs believe their morale has taken a battering in the last five years with over half (53.2%) saying it has got worse. Nearly two thirds (63.1%) believe changes to the NHS over the past ten years have made it harder to practise good medicine and only half (51.9%) would actually recommend a career as a GP to an undergraduate.

Laurence Buckman, chairman of the BMA's General Practitioners Committee said:

"GPs are worried about the future of general practice in this country, they have concerns about the negative impact current policies could ultimately have on patient care and they feel they are being attacked for achieving and surpassing government targets. That is why the morale of GPs is low.

"While many GPs can see a case for private providers having a limited role in delivering NHS care, the majority believe the widespread introduction of private providers into general practice would not improve the quality of care patients receive. We have serious concerns that the traditional core values of General Practice, in particular continuity of care, risk being lost as the government encourages increased private sector involvement. Yet it's that long-term relationship with a family doctor that patients say time and time again is what they value the most about UK general practice.

"There is the threat that care could become more remote from where patients live as more doctors are placed in fewer buildings, providing more impersonal and a poorer quality of care overall. Private providers could struggle to recruit and retain doctors, as most young GPs aspire to become partners in a practice, or they could look to cut costs by employing fewer doctors and more of other kinds of staff. Care could become more fragmented putting patients at risk."

The survey also shows that while around half (53.3%) of GP partners would consider extending opening hours if the resources were available, three quarters (72.5%) of GPs do not believe it is a good way to spend scarce NHS resources. Nine in ten (89.2%) doctors also say that the complexity of their consultations has increased since the introduction of the new contract.

The BMA believes extending surgery opening hours is not just about the GP holding extra appointments, it has to mean the whole practice team and hospital and community support services are available. If not, then evening or weekend surgeries would be of little genuine use to patients. Extending opening hours has huge resource implications.

Dr Buckman added:

"The current government agenda seems to emphasise quantity and speed over quality. When it comes to patients' health it is the quality and safety of care they receive that is most important. GPs are not against looking at new ways of working, and already tailor their services in flexible ways to meet the needs of their patients. The government's own survey showed 84% of patients are happy with their GP practice's current opening hours. Only four in a hundred patients wanted practices to open in the evenings and seven in a hundred wanted Saturday morning surgeries1.

"With regard to extending hours further beyond the current 8am - 6.30pm, GPs remain to be convinced. Without specific, additional funding for extended hours, current services will become harder to sustain. It will mean surgeries will have to close during the day so they can be open in the evening. Fewer daytime appointments will affect the patients who use and need us the most. It would be the elderly, the very young and those with long term conditions who would lose out.

"We need to see that the changes that are currently being mooted are for sound reasons and that they will really be of benefit to patients. If we are not very careful, we will have a private health service without continuity, provided by large businesses working from remote premises. We remain to be convinced that is what our patients want."

The full survey can be accessed at: bma/gp

1. In July 2007 the English Department of Health published the Patient Experience Survey. The results show that 84% of patients are happy with the current opening hours of their practice. The government spent £11 million carrying out the survey.

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