As we reach the end of the year, it’s a good time for the NHS to reflect, and see where we might be heading in the New Year.

The NHS has continued to struggle with the demand and financial restrictions that are affecting all parts of public services. It also became a key battle ground as part of the run up to the General Election which eventually saw a change of government, for the first time in 14 years.

It is too early to see the direction the new government are taking the NHS in, but there have been some interesting promises, and we should give them a chance to be implemented.

Undoubtedly some of the plans will meet resistance, but we have to find a way through the issues and - dare I say it - look at changing the way we work.  

This will be easier if we are open to changing processes, rather than having them imposed on us.

There are certainly no easy fixes to the problems, and some areas will suffer where others will benefit from possible extra funding. The acknowledgment by Wes Streeting that Primary Care only gets about 6% of the NHS budget but does over 90% of the work has to be welcomed, and this is being looked at. 

In 2024 Primary Care faced a large increase in the minimum wage which adversely affected all of us, as most non-clinical staff are working on either the minimum wage, or just over. 

In 2025 we will be facing an even worse situation; the minimum wage increases again, as do employer National Insurance rates, the starting rate being set at £5k down from £9K, and it will affect every practice.
Surgeries have been working out the costs and, in many cases, it is tens of thousands of pounds. Unless the income into practices increase, practices will have some very difficult decisions to make. There is now a real risk that practices may close, adding even more stress on to neighbouring practices.

Salaried GPs and Locums 

To highlight the financial struggles in 2024, there are a glut of locums. In 20 years, I have never seen anything quite like it!

Practices have had to look at their expenditure and are having to cut back on locum use. It has also been possible to negotiate terms and lower payments as a result of a shortage of work.

It is true that locums have had it good for many years, but so many are now thinking of having to become salaried. The proof of this is that during 2024 we had several vacancies for salaried GP, and we had a huge number of applicants, again, something unheard of in the past.

Physician Associates

Another issue that is going to run into 2025 are Physician Associates which I have highlighted several times this year.  

Surgeries that have taken them on are now either having to redeploy them, or make them redundant, as the scope of work has been drastically cut, meaning they are not cost effective.

There is a review going on which hopes to report in March 2025, but the signs are not good, and I feel particularly sad that the Physician Associates have been sold what looks like a defective job role. 

Practice Managers

As Practice Managers, we are well aware of the stresses of the work, and a recent poll suggested 38% were considering leaving the role, showing the level of burnout we are facing. 

There is also talk of regulating the role, which would put even more pressure on the role. Those looking at the regulation probably have little or no experience of the role and it could be another disaster for the profession. 

In Conclusion ...

So, 2025 is again going to be another very challenging year and we will need to be prepared to weather the storms ahead.

Finally, can I wish you all a Merry Christmas and a Happy New Year!

The Secret Diarist