GPs in Cumbria are working 16-hour days as they struggle to recruit new doctors

Long-standing problems attracting new GPs mean many practices are facing growing pressures, with some having less than half the number of doctors they need to meet patient demand.

Local NHS leaders have long been warning of a potential crisis facing general practice, with about a quarter of doctors in the county now approaching retirement age.

In west Cumbria, where the problems are worst, one practice has already announced it will close next week.

Whitehaven Medical Centre was run by Dr Tom Ickes, who had previously spoken of difficulties facing GPs.

Doctors behind Carlisle's so-called 'super surgery' have also revealed that had they not gone ahead with a controversial merger, the North Carlisle practice was in danger of folding.

Senior Barrow GPs have also previously warned of recruitment problems hitting general practice, with Dalton's Nelson Street Surgery closing a few years ago when its sole GP retired.

Cumbria's health leaders say that there are problems right across the county, prompting them to look for new solutions.

One move, which is already attracting national attention, is to set up a new NHS partnership to take over the day-today running of practices, leaving GPs to concentrate on caring for patients.

Other efforts to tackle recruitment have included 'golden handshake' payments for those coming to work in Cumbria, and creating jobs that combine GP work with research to make them more attractive.

John Howarth, a long-serving Cumbrian GP who is also deputy chief executive of two county health trusts, said that although Cumbrian GPs are providing good care, pressures are growing.

"General practice has been a very strong part of the whole health system. More practices are being rated good or outstanding in Cumbria than other parts of the country," he said.

"But some practices are struggling, particularly on the west coast. The number of doctors is decreasing, and has been for a number of years, making it very difficult to recruit."

"There are doctors all over this county that are working 16-hour days. Getting appointments is increasingly difficult, but some doctors simply can't work any harder."

David Rogers, medical director at North Cumbria Clinical Commissioning Group (CCG) said the Cumbrian issues are part of a bigger crisis that is facing primary care across England.

"I think we have to put it into a national context. The plan nationally was was to have 5,000 more GPs, but from 2015 to 2017 we've lost 1,300. Rather than going up, the numbers have gone down.

"Then there's the age profile. Something like 19 per cent of GPs are over 55, similar to other professionals in the health service.

"Nationally, a number of practices have merged or closed. All of primary care is under pressure," he explained.

Barrow GP Geoff Jolliffe has previously called on the Government to make the general practice more appealing.

He warned there were more people moving out of the profession or retiring early than new GPs coming in.

Dr Rogers said more medical school places are being made available, but it will take time to train up new GPs.

"Overseas recruitment is also underway. We are hoping to see some come through this year, hopefully 13 in Cumbria," he added.

Dr Rogers said the development of the University of Central Lancashire (Uclan) Cumbrian medical campus will be key.

Not only will it train up new staff, it also opens up new research and teaching opportunities for GPs, making the jobs on offer in the county more attractive. He added that bigger practices, like Carlisle Healthcare, are also able to take on other health staff, such as nurse practitioners, pharmacists and physiotherapists, to ease pressure on doctors.

"I think what's happened in Whitehaven has really showed the fragility of single-handed practices. In Carlisle, they've been able to do some of what they've done because of their size," he said.

Cumbria's longer term masterplan for healthcare includes integrating primary care with hospitals, social services and others.

Dr Rogers believes that will also help. "That's the future. We need more working together," he said.

"Obviously in Whitehaven we know it's pressured. Workington has similar staffing and recruitment problems, but through the local access centre they've been able to work through things together. This all suggests that working at scale, where appropriate, is the right thing, though we still want patients to have continuity of care."

He added: "We are moving forward on recruitrment, but only seem to be able to replace what we are losing. It is difficult. We recognise that practices are stressed. That's why we need to work collectively to treat patients and continue to deliver good services."