They've been described as the 'beating heart' and the 'backbone' of the NHS. And for most of us our local doctor is our first and most frequent point of contact with the health service.
GP surgeries deal with about 90% of NHS patient contacts for around 10% of the overall budget. But with a shortage of more than 2,000 GPs in England alone and with doctors quitting in unprecedented numbers amid concerns about the 'unsustainable' workload, what does the future hold for general practice?
As the NHS turns 75 we spoke to a number of GPs and health bosses across Greater Manchester and the UK to hear their thoughts, fears and hopes for the profession.
'I know how great the NHS is and what it can do for people'
Dr Kamran Khan, a GP at Unsworth Group Practice in Westhoughton, Bolton, is the chair of Bolton GP Federation. He said: "General practice, like the rest of the NHS, is working beyond capacity on a daily basis. Demand is through the roof and I don't think that's necessarily just down to covid, it's been coming for a while and covid just accelerated it.
"It can be incredibly frustrating for patients when they're not able to access services. It's incredibly frustrating for staff as well.
"But the enthusiasm for the NHS is still there. There is an unstinting loyalty, but you cannot take that for granted. You can't continue to run on goodwill to keep going above and beyond."
Try MEN Premium for FREE by clicking here for no ads, fun puzzles and brilliant new features.
Dr Khan hopes last week's long-awaited NHS workforce plan, setting out how thousands of doctors and nurses will be trained, will help ease the pressure, but warned much more needs to be done.
He said: "I hope the workforce plans goes some way to improving things, but it's not a cure all. We need to invest and that's not always about pay. It's about feeling valued.
"If you were a young person leaving university now, would the NHS be high on your list of workplaces? I'm not sure it would.
"There needs to be a genuine and significant drive to improve community care - and that means all community services, including social care. Slogans like 'joined up' and 'integration' have been around for ages, but we need to ask why have these things never come to fruition.
"We need to provide a service in the community, close to people's homes. And we need the continuity of care. In the past your GP knew you and your family and could probably deal with a lot of things without the need to medicalise them. You need to build those relationships, because if you don't do that it becomes more transactional.
"It seems boring and it doesn't grab the headlines but it's what needs to be done."
And Dr Khan says it's vital the NHS is made fit for purpose for generations to come. He said: "I am an eternal optimist. I know nothing but the NHS. I come from a working class part of Bolton, where the life expectancy is 10 years less than some other parts of town.
"You only need to look at places with private healthcare systems to see how that it just widens inequalities. We just cannot have that here. I know how great the NHS is and what it can do for people. It just needs genuine attention and care."
'When it fails, the NHS fails'
Dr Khan's optimism isn't shared by everyone though. According to the British Medical Association the number of GPs in England has fallen by 2,165 since 2015, to the equivalent of 36,468 full-time doctors. But that smaller workforce is seeing more patients than ever.
Last year 340 million appointments were delivered, a 9% increase on 2019. In a scathing report published in October the health and social care committee described general practice as being 'in crisis' and accused the government and NHS England of ignoring 'unsustainable' workload pressures and a growing shortage of medics.
The failures were putting the safety of millions of patients at risk, MPs said. "General practice is the beating heart of the NHS and when it fails, the NHS fails," the report said.
"We know up to 90% of healthcare is delivered by primary care. Yet currently the profession is demoralised, GPs are leaving almost as fast as they can be recruited, and patients are increasingly dissatisfied with the level of access they receive.
Join our WhatsApp Top Stories and Breaking News group by clicking this link
"The first step to solving a problem is to acknowledge it, and we believe that general practice is in crisis … despite the best efforts of GPs, the elastic has snapped after many years of pressure. Patients are facing unacceptably poor access to, and experiences of, general practice and patient safety is at risk from unsustainable pressures."
Last month the General Medical Council warned urgent action was needed to break a 'vicious cycle' of unmanageable workloads and burnout that is causing doctors to quit. It published the findings of a survey which showed the number of doctors who reported working beyond their rostered hours on a weekly basis rose from 59% in 2021 to 70% in 2022, with 42% saying they felt unable to cope with their workload each week (up from 30% in 2021).
Just half said they were satisfied in their work, down from 70% in 2021. Responding to the findings Prof Kamila Hawthorne, Chair of the Royal College of GPs, said it was a 'stark reminder of the workforce crisis facing general practice'.
She added: "'Vicious cycle' is an increasingly accurate description of day-to-day general practice as a dwindling number of GPs face an almost impossible workload, that continuously grows in both volume and complexity. We are delivering millions more appointments compared to before the pandemic, with almost half on the same day of booking.
"But we are doing so with 930 fewer fully qualified full-time-equivalent GPs compared to 2019. It is little wonder that our own College survey suggests a further 22,000 GPs could leave in the next five years. The bottom line is, we need thousands more GPs, but the numbers are going in the wrong direction."
But Prof Hawthorne also sounded a note of optimism, adding 'it is not too late to turn this dire situation around'.
"The long-awaited NHS workforce plan is the opportunity to make sure general practice is fit for the future. We need to see a bold new plan from the Government that goes beyond the target of 6,000 more GPs it pledged in its election manifesto, including revitalised recruitment and retention schemes."
'You can't keep running on goodwill'
Dr Murugesan Raja is the associate medical director for NHS Greater Manchester and a GP at Hawthorne Medical Centre in Fallowfield. He said: "General practice is still a wonderful place to work and the reason is the continuity of care you can offer and the relationships you can establish over years and years.
"But like the rest of the NHS general practice has it own share of problems with workloads, training, retention, delays in elective care, delays in emergency care.
"It's about making it a more lucrative place to work with investment in funding, estates and staff. We need more investment in deprived areas because they are ones that struggle the most.
"There are much more lucrative offers to work in the Middle East, in Canada. They need more GPs and the pay and workload is much better. Family ties and being invested in the NHS probably keep people here, but you can't keep running on goodwill."
Dr Raja admits the system is 'creaking' at the moment. But despite the crushing workload, he says GPs are still doing a good job. He said: "GPs are still delivering the right care. We dealing with more appointments than ever. Patients are being seen and are being treated.
"General practice is doing a good job. It's the bedrock of the NHS. We keep people well for as long as possible.
"But when that system starts to creak, like it is now, you see more pressure on 999, 111, A&Es, walk-in centres, hospitals.
"We need more retention, we need to increase the number of GPs and invest in the estate. We need to increase accessibility for patients, whether that's digitally, for those that are able, or other ways for those are not.
"If that's done well the hospital workload goes down, then they can do a better job. If we treat general practice better the others bits of the NHS get better.
"I have to be optimistic. There is nothing like the NHS. There is nothing like the brilliance of getting the right care, straight to the point without any barriers.
"It's one of the most ideal systems in the world. We don't realise how fortunate we are to have it.
"It's an incredible resource for the country. At the moment it's struggling, but by working together things will get better. We just need to keep shining a light on the situation."
'It's in the hands of the government and the policy-makers'
Dr Zahid Chauhan is a GP and a Labour councillor in Oldham. He said: "It's excessive demand to the level where you think 'Is it safe to provide a service?'
"We know we have a deflated and demoralised workforce, who are working harder than we've ever worked before, but we also know that the public are still not satisfied and the service is not meeting the general need. People are emigrating to Dubai, Qatar, New Zealand where the money is much better, the lifestyle is better and there's not as much demand or pressure.
"But there is not much on a professional basis individually we can do about it. It's a system fault. It's in the hands of the government and the policy-makers.
"Every government says we want more GPs, more nurses, but they aren't willing to go beyond the headline and get down to the nitty gritty. It's not that we don't have the capacity to train more doctors, it's that we don't want to invest in the training.
"I know for instance of a university with 250 places in its medical school, but 235 of those are for self-funded overseas students."
Dr Chauhan hopes public pressure will ensure the long-term future of the health service, but also says patients need to be educated on the changes the future might bring. "I hope things will get better. The public loves the NHS and I think they will demand it gets better," he said.
"Historically general practice was GP, nurse and patients. In the last few years we have incorporated lots more different roles.
"The future model is GP-led, but with the GP working with more people who are better qualified in specific areas. In certain cases that might mean you see a well-qualified nurse, or end up seeing a pharmacist based on your need.
"That's a good thing, but we haven't properly educated the public about that. And also I think the public needs to be more realistic. Do you really need to see a GP for a sore throat for instance?"
Love Greater Manchester? Love feature writing on the services that keep the city running? Our new app is the new way of exploring M.E.N storytelling. Find out how to try it here
