Sittingbourne loses nearly 40% of its GPs in 3 years
We all know how difficult it can be getting an appointment with a GP, but what do we really know about the overall provision in Swale and what plans are in place for future provision?
I set out to try and find two data points, one pre-pandemic and one post-pandemic. Obviously, I needed to be able to easily compare the data and eventually managed to locate two sets of data provided by the NHS exactly three years apart, in December 2019 and December 2022.
The figures highlight a huge inequality in the level of GP provision across Sittingbourne, Sheppey and Faversham and that only looks to grow.
Surprisingly at the time of publishing this article I was astonished to find that Faversham actually has more GPs than Sittingbourne, albeit only one more, but given that Sittingbourne has 70,995 registered patients and Faversham only has 33,279 you don’t need to be a rocket scientist to understand the scale of the problem.
I want to be clear that this is not an exercise in bashing GPs or the NHS, but one about highlighting our current position, so that better decisions can be made going forwards.
- Swale GP patient ratios worse than the South East average.
- Sittingbourne and Sheppey have 23 less GPs than 3 years ago.
- Sittingbourne and Sheppey GP patient ratios are getting progressively worse, whilst Faversham is improving.
- Initiatives by the NHS Kent and Medway Integrated Care Board to recruit more GPs are woefully inadequate.
- Surgeries with the worst ratios are excluded from financial incentives in current recruitment drive.
GP Patient Ratios
I am aware that GP patient ratios are not going tell you how good or bad
the level of care provided by your GP is, nevertheless, they do provide some
context as to why you might be finding it more challenging to get an
appointment with your GP compared to other practices even in the same town.
According to the Office for National Statistics across England the number of patients per fully qualified GP has increased from 2,100 in October 2018 to 2,300 in October 2022. However, over the same period factoring in trainee doctors the ratio has decreased from 1,800 to 1,700, suggesting that there are fewer fully qualified doctors now than there were four years ago.
Looking at the data by region, it probably comes as no surprise that the Southeast and London are the worst areas of the country.
Number of patients per full-time equivalent staff member by region, England, October 2022
Sorce: Office for National Statistics - Trends in patient-to-staff numbers at GP practices on England.
What Is Full-Time Equivalent?
Before we look at the figures for Swale, I need to explain what is meant when I talk about full-time equivalent GPs.
Full-time equivalent is a measure of the number of hours both full-time employees and part-time employees work and how this would equate with the number of hours considered full-time for one employee.
This is necessary as many GPs do not work full time, or at least not exclusively for the NHS. So, you might have 4 GPs in a practice, but if they are all only working for 2 and half days a week, the practice would have a full-time equivalent number of 2 GPs.
This is important as it is used to determine the GP patient ratios to make a fair comparison between practices.
How does Swale compare with the national average?
If you recall from earlier in the article, the national average for all GPs is
1,700 patients per GP. The chart below shows the numbers for every practice in
Swale. The worst having more than 6 times the number of patients per doctor than
Only Faversham achieves numbers close to the national average, with every single practice in Sittingbourne and Sheppey being above the national average and two, in particular featuring amongst the worst in the entire country.
The dotted red line is the average for England
Note: We managed to obtain figures for Iwade Health Centre in
2019, but as of last year the practice was taken over and their figures are now
reported to the NHS as part of the parent group, so it’s impossible from the NHS
data alone to ascertain exactly where we are now, but the parent group has a GP
patient ratio of 10,758 and the last recorded figures from June 2022 show a GP
patient ratio of 10,492, so as they are only 6 months out of date those are the
figures used for comparison purposes.
Who looks after GPs locally?
Until recently local bodies called Clinical commissioning
groups (CCG) acted as the governing body for GPs. Sittingbourne and
Sheppey were part of the Swale CCG and Faversham part of the Canterbury and
Personally, I believe that the effectiveness or not of those bodies, played a part in the situation we now find ourselves in. Combined with differing levels of development that the three main towns have seen in our recent past, it’s hard not to see a causal link between the volume of development, the legacy of the Swale CCG and the ratios.
The whole of Swale now falls under the control of the Kent and Medway Integrated Care Board.
Projecting population growth
The 2011 census data shows a population of 135,800 for
Swale. The 2021 census showed that population had grown by 11.7% to 151,700.
This fits very nicely with the NHS data from which I derived the total registered patients in December 2022 as 151,790 a rise from 147,900 in December 2019 an uplift of 2.6% over 3 years.
In very simple terms if we were to project that same growth going forward over the next decade, and this is probably horribly wrong but let’s roll with it for now, we would have an increase of 17,759 people in Swale. That’s a requirement for 10.45 new full-time equivalent GPs, roughly one new full-time equivalent GP every year based on average ratios.
What is being done to recruit more GPs?
At the end of March last year the NHS announced a package of
£500,000 to be spent over a 2-year period to combat the dire shortage of GPs in
the most disadvantaged areas of Kent.
This initiative was aimed at recruiting 20 additional doctors across Medway, Swale and Thanet.
The NHS have highlighted that some parts of Kent have just one GP for every 7,000 patients, this was rather generous given that we know and have known for some time that some parts of Kent have ratios well in excess of 10,000 patients per GP including the surgery at Iwade with its ratio of 10,492 patients per GP.
I did enquire about progress of their campaign, and the NHS Kent and Medway Integrated Care Board told us “The campaign is ongoing so we are not in a position to share outcomes yet but will be doing so in the next couple of months.”
Very kindly the Kent and Medway ICB also provided a link to an article from 10th January 2023 discussing their ‘Be Here’ in the garden of England campaign. Which states, “The campaign aims to recruit 20 new GPs to Thanet, Medway and Swale in the first phase.”
The Kent and Medway ICB are attempting to entice GPs with two separate schemes, a ‘GP Attraction Offer’ and ‘Coastal Fellowship Offer’.
However, I am horrified to see that the GP Attraction Offer which offers a welcome payment of up to £15,000, is not available for five out of the eight practices in Sittingbourne and worse than that it excludes the three practices with the worst ratios.
Why this poorly targeted campaign includes Grovehurst Surgery, which has one of the best GP patient ratios in Swale is beyond me. The inclusion of the Meads Medical Practice is also a very odd choice. Other practices on the list are Chestnuts Surgery, Sheerness Health Centre and St George's Medical Centre.
The ‘Coastal Fellowship Offer’ is equally selective featuring the OM Medical Centre, St George's Medical Centre and Vel Surgery all in Sheppey and the three best performing practices out of the five on Sheppey.
Something has to change and soon?
The previous Swale Clinical Commissioning Group stated in
their 2019-20 annual report “In Swale GP primary care services are fragile and
further population growth will put increased pressure on local services if the
workforce requirements are not able to keep up with demand.”
Over the last 3 years we have lost 17 GPs in Sittingbourne and 6 GPs in Sheppey whilst conversely Faversham has gained 5 GPs. This is the polar opposite direction of travel that we should be taking and with recruitment plans limited to just 20 GPs across three areas of Kent and factoring in continuing population growth the Kent and Medway ICB are planning to fail and fail rather badly at that.
Obviously there are many reasons why GPs are leaving, early retirement, stress and being overwhelmed with work to name but a few. Poor access to GPs is having a major impact on A&E services. There is concern over NHS 111 handlers 'referring too many people to A&E' and patients ending up at A&E are typically more seriously ill through lack of diagnoses.
The number of registered patients in Swale, according to the NHS data, has grown by 4,142 patients in the last 3 years, equating to the need for another 2.4 full time GPs based on the national average.
Across Swale we would require the full-time equivalent of 89 full time GPs to get in to line with national averages, that is approximately 119 GPs based on current working patterns or an increase of 160%.
We currently have 74 GPs operating at the full-time equivalent of 55.4. This is down from the 92 GPs we had 3 years ago who operated at the full-time equivalent of 59.6.
Whilst I am sure that someone will argue that we have only lost 4 full time GPs in real terms, it does not take away the fact that 23 GPs left their practices in Swale over the last 3 years alone. That is a staggeringly large number and if even some of them had been persuaded to stay, we would be in an entirely different position now.
Clearly the current campaign and ambitions of the Kent and Medway ICB generally are nowhere near sufficient and whilst any additional GPs are welcome this is no more than a sticking plaster for a service that is currently haemorrhaging GPs.
One question that I hear far too often is, why given that nearly 50% of the population of Swale resides in Sittingbourne, does Sittingbourne not have any emergency GP provision when both Sheppey and Faversham do. I simply do not know how can the Kent and Medway ICB justify this and it almost appears as if some areas of Kent are given preferential treatment.
Quite simply any notion that health care provision has in any way kept up with the levels of housing development are utterly demolished by the data. In fact, if anything, the level of care provision is in decline.