Do GPs have a victim mentality?
Knee-jerk reactions to policy threaten the profession’s reputation and its relationship with patients, says primary care tsar Dr David Colin-Thome. Dr Robert Morley disagrees, arguing that challenging politically motivated, unjustified criticism isn’t playing the victim, but standing up for the profession
Knee-jerk reactions to policy threaten the profession's reputation and its relationship with patients, says primary care tsar Dr David Colin-Thome. Dr Robert Morley disagrees, arguing that challenging politically motivated, unjustified criticism isn't playing the victim, but standing up for the profession
You can't generalise about a profession and of course not all GPs have a victim mentality.
But to look at whether an element of this exists requires a careful look at the nature of the job, how it has changed and how it's likely to change in the future.
I have now retired after 36 years in the same practice but I have loved being a GP. Would I be a GP if I was a young doctor again? Of course.
To have continuing responsibility for people – rather than simply for a disease – is particularly fulfilling and is something I hope GPs will always value.
But there is so much more to do and general practice can lead the NHS in looking after the needs of the individual and yet take responsibility for the population too.
All this lies well within the scope of GPs, either in single practices, in consortiums or in the RCGP ‘federated practice' approach.
So what better job can there be? And yet in my total of 40 years in the NHS I cannot remember a year when there was not a claim of low morale.
So what is the reason for such negativity?
We're still the best-loved NHS clinicians, we have huge influence over many aspects of the health and well-being of our patients and are usually the local clinical leaders. We also have huge control over our working lives, making us the envy of so many.
We have been given increasing influence in the NHS over the last 17 years and yet every policy that offers us that influence has been criticised, opposed and even vilified by so many – fundholding for instance.
I even regarded the anti-fundholding movement as a success of that policy as it got GPs off their backsides.
Rewarding good practice
Since then we've been given the lead clinical role on PCTs and in practice-based commissioning – which the Department of Health is determined to reinvigorate – and a contract that rewards good practice and has made us probably the best-paid GPs in the world.
Of course, we are – just like the rest of the professional world – more accountable.
So I repeat – what better job can there be?
But if we are to lead – or at least influence – the development of high-quality practice we need to combine clinical autonomy with an acceptance that we also have to offer systematised care.
This is not ‘cookbook' medicine – a frequent and uninformed criticism of the QOF. The care of patients – especially those who live with a chronic condition and make up the bulk of our clinical work – needs also to be about systems and processes that allow us to diagnose the undiagnosed, consistently review our patients in order to offer them evidence-based care and ensure patients are not lost to follow-up. We have to offer both personal and systematic care to be good 21st century doctors.
So do GPs have a victim mentality? In everyday practice I would generally say No (but with many exceptions).
But do GPs display a victim mentality when a new policy initiative emerges – especially if we are held more to account? A sizeable minority does, and accompanies this with spurious claims that the Government does not value GPs.
Does this publication encourage such a negative approach? Undoubtedly Yes.
Is it helpful to the profession and its continuing success? Indisputably No.
Could it harm our standing with those who love us the most – our patients? Resoundingly Yes. Witness the recent campaign to frighten them when their care is not under threat.
The recent Department of Health primary and community care strategy offers us an even more extended role and influential position but the deal will always be with accompanying accountability.
Are we up to it? As a profession we are and no good practice has anything to fear from any policy.
After all, good general practice is the resounding success of the NHS. Long should it continue. And since it is so successful, popular and well resourced, it needs to be accessible in all meanings of the word.
Dr David Colin-Thome is national clinical director for primary care and recently retired from his post as a GP in Runcorn, Cheshire
Victim mentality is characterised by an inability to take personal responsibility for your situation, regardless of circumstances, with the inappropriate laying of blame on others.
It also suggests an unwillingness to challenge or improve your situation.
I don't recognise this picture when considering the profession's response to its increasingly shabby treatment by the Government. GPs have rightly challenged example after example of appalling behaviour.
We have stood up to be counted and shown our willingness to take positive action in the face of constant, unjustified, politically motivated criticism and mounting uncertainty in just about every aspect of our working lives.
Consider the Government's performance since it became clear how much and how well GPs were delivering on the new contract: anti-GP spin and propaganda fed to the media, false and unproven accusations, broken promises, illegal attempts to reduce our pensions, gun-to-the-head negotiating tactics, bullying, unacceptable unilateral contract impositions and increasingly insulting and desperate language against us.
Worst of all is the cynical privatisation agenda, fuelled by misinformation, talk of singlehanded practices being ‘grubby' and ‘crappy' and of practices having ‘gentlemen's agreements' not to register each other's patients.
Robust but appropriate
Contrast this with the profession's response – robust but proportionate, honest and dignified, while continuing to rise to the challenges of delivering more and better care to our patients despite diminishing resources.
Nothing in the way we have handled this sorry catalogue suggests the supine and helpless attitude of ‘victim mentality'.
On the contrary we continue to hold our heads high, buoyed up by the evidence recently harvested in practices across the land.
The magnificent and unprecedented response to the Support Your Surgery campaign petition – more than 1.2m signatures in just three weeks – confirmed what we have always known.
Patients trust and believe their doctors, not politicians, to act in their best interests.
They understand that we deal in truth and integrity, rather than misinformation and dishonour.
Of course the Government understands this too, so its reaction has been as entirely predictable as it is shameful; accusations of hysteria, of misleading the public and even of coercing vulnerable patients to sign petitions.
Needless to say, not a single jot of evidence has come to light to justify this disgraceful slur. Government behaviour reached its nadir when the health secretary dredged up a wholly inappropriate quote about Nazi Germany when making a ridiculous comparison between the Support Your Surgery campaign and BMA concerns over the founding of the NHS 60 years ago.
When politicians resort to using the N word, be in no doubt – they are desperate and they have lost not only the argument, but the plot.
The current prime minister, secretary of state, health ministers, political advisers and civil servants will all be long gone when we remain, doing what we have always done – providing the world's best primary care service.
Is general practice victimised? Definitely. But do GPs have a victim mentality? Definitely not.
Next April will bring possibly our greatest ever challenge, when, across the country, new health centres and surgeries, many certain to be run by commercial giants, start to compete for our patients.
US business guru Jeffrey Gitomer said ‘customer satisfaction is worthless, customer loyalty is priceless'. Of course, we don't have customers, only patients.
We will continue to ensure they remain both satisfied and loyal. This will be our biggest battle. GPs are up for the fight. Let's bring it on.
Dr Robert Morley is a GP in Birmingham, executive secretary of Birmingham LMC and GPC regional representative for Birmingham and SolihullDr David Colin-Thome
I cannot remember a year when there was not a claim of low moraleDr Robert Morley
GPs rightly challenge examples of appalling behaviour.