Wednesday, 30 December 2015

Dont know what they've got

Don’t it always seem to go.......

This is not a sob story about the plight of GPs. It is however a warning to the British public. What you tell us you value about general practice, the fact that there is a GP and practice team who know you, the fact that you can get an appointment if you need one without paying, the value of someone knowing your family and circumstances, that will soon be gone if Mr Hunt gets his way.


If things don’t change, you will very likely not have a free at the point of use family doctor in your area. You may not even be able to get a GP at all. 40% of GPs are planning to retire in the next 5 years, many are emigrating, lots are off sick because the job has made them unwell. There is a similar crisis in our practice and district nursing teams on whom we depend hugely. There will of course be GPs around, but you will have to pay them privately because NHS General Practice will not be financially viable and there wont be enough GPs to keep it afloat. You will have to pay for your medicines and tests and any free service that does exist will almost certainly be staffed not by doctors but nurses (who are also in short supply and overworked) and, if Mr Hunt gets his way, physicians associates with 2 years postgraduate training. The familiar, well trained expert medical generalist will be gone. 

How have we got to this sorry state?

There is a fundamental lack of understanding of what GPs do by, well to be honest, it seems everyone except GPs, their staff and the patients who need us often and depend upon us.  I will see on average of 36 patients face to face every day and unlimited numbers of phone calls and home visits on top of that. Some patients come twice per week, some once every 2 years, some once every 20 years. But as a team we are there when our patients need us. We even see anyone who has a medical need to be seen on the same day.  As a profession, we do 90% of all NHS patient contacts for 8% of the NHS budget, we get approximately £120 per person per year, however many times we see them (how much do you pay for your sky TV/pet insurance/mobile phone every year). We are running out of money, time and energy. On one day I will do gynaecology, paediatrics, psychiatry, general medicine, renal medicine, cardiology, surgery, child protection, end of life care and sometimes, very importantly, just listen to a distraught or bereaved person who feels that they cant go on.  All in 10 mins per patient. And if I miss anything or make a mistake I may harm someone and I will have lawyers, the GMC, NHS England and the CQC on my back. As a result my insurance is approximately £450 per month for 2 days per week.

Why am I telling you this?

As part of my role in Resilient GP, I listen to thousands of GPs, practice nurses, nurse practitioners and practice managers every day, discussing the current state of their practices and the personal struggles they are having. Many require their own GPs and medications to keep them going, many are planning to retire early, many are leaving for foreign shores.  I am also an avid social media user, and frequently read some of the vitriolic press written about GPs and even worse, the responses of some of the British public to those articles. I have now stopped reading the comments actually, they either make me cry because they are so unpleasant or they make me so angry I cant think straight.
The reason these are so personally upsetting? Because almost every practicing GP in this country goes to work daily with the mission of recognising illness, diagnosing it correctly, managing it and doing what is right for the person in front of them. Some of us make mistakes, none of us are perfect and some of us are burned out, but the vast majority are desperately clinging on to the wreckage of general practice that has been created by the current government as “penance” for our contract in 2004 according to Mr Hunt.  For doing this, we are criticised almost daily by the press, the government and the general public. How often have you heard “I went to the GP, they told me it was a virus and they didn’t even give me antibiotics? They couldn’t be bothered to do anything, its disgusting”.  I hear that, often, from people who don’t know I am a GP.

What do we need the public to do? 

If you value having your GP down the street, if you don’t want to have to pay to see us, if you care about having someone who knows you and your family looking after you, please understand that what I am telling you today is reality. It isn’t spin, it isn’t looking for sympathy, it is a warning. An oft said phrase I hear at GP meetings and said with a sad sigh is “they won’t know what they’ve got till its gone”. The government and some of our more biased press and media will have you believe that we are simply lazy, possibly dangerous, want to be paid too much and just need to work differently to make General Practice continue. Believe me, we are working our socks off to keep things going, we don’t get paid as much as fellow professionals with similar training,  we are looking at ways of doing things differently, but it currently feels like rearranging the deckchairs on the titanic with a gun to our heads.

If you care, if you want things to continue, please write to your MP, stop believing the govt rhetoric and Daily Mail propaganda and consider the reality that General Practice is going under. Use us appropriately, value what you have and work with us when the system goes wrong. Help us to fight for a service which is the envy of the world.

1 comment:

  1. If anything, this warning understates matters. The gap between those coming up to retirement and those in training will leave 8-10% of GP posts empty by the time of the next election. One in three female GPs in their 30s leaves the profession permanently - and at a time when 80% of GP trainees are female, this is a loss rate that will be catastrophic.