Published: 11/07/2002, Volume II2, No.5813 Page 6 7

The government will not meet its targets to increase the number of GPs if current staffing trends continue, a report from the Audit Commission warns.

The report - which aims to provide a baseline of evidence on primary care to be followed by a detailed review next year - says the government may be expecting 'too much, too soon' from general practice.

It suggests the history of patchy investment and limited management capacity in primary care trusts means that practices are struggling to meet today's agenda.

The paper calls for a national strategy to make better use of nurses in general practice and to improve the use of community pharmacists.

One-third of GPs are female, and two-thirds of medical students wanting to go into general practice are women, the report notes. It suggests the traditional model of a GP 'principal' staying in one practice full time for their working life is increasingly outdated, and says that in the short term this may make it difficult to deliver all that is needed from general practice.

Examining recruitment targets for 2008 of a net increase of 15,000 GPs above the 2001 level, it says it is not clear if this includes the extra 2,000 GPs outlined in the NHS plan.

'If the numbers are additional, current figures suggest the government is going to find it difficult to 'grow' enough GPs to meet these targets, ' the report says.

The report also says that so far, the impact of new forms of primary care - like walk-in centres and NHS direct, has been 'marginal'.

The commission acknowledges low morale in the workforce and problems in recruitment and retainment, with one-third of GPs and practice nurses approaching retirement age. Yet the report says that 'despite the perception of a marked increase in general practice workload, there is little hard evidence to confirm this'. Data for the past decade shows increased consultation times, smaller patient lists and reduced out-of-hours working. The average consultation time is now 9.36 minutes.

It found inequalities in funding across England, with twice as much funding per head in Oxfordshire than in Gateshead. It showed large variations in the way services to patients are delivered, quoting a study which shows only half of patients with diabetes had received appropriate eye checks.

'Some areas are spending six times as much as others on drugs that are known to be less effective, ' the report warns.

It finds considerable variation in the quality of care and in prescribing. Most areas are now meeting the national standard for 72 per cent of all items to be prescribed generically, but a few practices in some areas are reaching less than 40 per cent. The report also flags up the fact that increased spend for statins - used for secondary prevention of heart disease - is not evenly spread across the country.

It says that while more work has shifted out of hospitals, there has not been a corresponding shift in the balance of resources.

Growth in spending has risen by 20 per cent in real terms over the last ten years, compared with over 60 per cent in hospitals over the same period.

www. audit-commission. gov. uk