'I am not prepared to leave general practice a worse place than when I joined'
I am standing for RCGP president because I believe in general practice and it is now in a worse place than I can ever remember during my thirty plus years as a GP. The working day has become undoable. Nothing short of a radical overhaul will get us back on our feet. Three steps are required.
The first will be a complete rethink at every level, from training to retirement, about how we regenerate the principles of the family doctor providing personal care and continuity as well as the level of access and extended service that is now being asked of us.
It will require an almighty black eye in a dysfunctional and hypocritical system that has cut general practice’s share of the NHS budget by 25%, while talking about a primary care-led NHS.
This will need to start with training and education. Is it surprising that barely 20% of doctors want to become GPs (we need 50%), when young doctors spend only between 3% and 13% of their training in general practice and are frequently exposed to bias and whispers against GPs?
There will also need to be a fundamental overhaul of funding streams. General practice can’t move forward when it is threatened with PMS/MPIG reviews and offering extra services receives only non-recurrent funding. It is time for the system to take general practice seriously.
Nothing less than a national commission will provide the punctuation and weight now required to help general practice on its feet. The commission will need to work with the College and the profession to recreate general practice as a fulfilling career for GPs both new and seasoned. Politicians now seem to accept that this is necessary.
The second change required has to do with the image and perception of general practice.
When I chaired a conference on primary care in Birmingham last year, I was surprised to hear from GPs in the audience that one of the main causes of grief for them was the adverse publicity in the press: ‘greedy GPs’, ‘never there’, ‘don’t care’. It is so different from the headlines that general practice received in the press thirty years ago. Turning this round will require an Alistair Campbell level of aggressiveness combined with an ability to relate and convince the press at all levels. This is a challenge that I particularly relish as a frequent writer and broadcaster with credentials extending from having been president of the Health Writers’ Guild to a columnist on SHE Magazine.
My third ambition is about respect and status. If I type ‘Royal College’ into Google, I get the choice of surgeons, physicians, psychiatrists or nursing but not general practitioners.
As the College with the most members and with general practice being essential to future NHS sustainability, I want to see the Royal College of General Practitioners at the top of such a list. Recently, two of my elderly patients said to me in surgery: ‘Dr Dixon – we have decided you are so good that they really should make you a consultant’.
General practice has been rightly described as the most difficult job in medicine. I believe that it is and it is the most difficult to do well. It is also now at the centre of the NHS with our new roles as extended providers and commissioners. As RCGP president, I will help end this secondary care centric system that elevates specialists over generalists as the ‘senior service’.
I am an outsider in the presidential race though I have written three books and published a range of original research. My credentials are much more to do with my political and media experience and trying to connect these with my continuing role as a frontline GP.
My motivation is that I am not prepared to leave general practice a worst place than when I joined. I am fired by my two GP children and hearing many young doctors, in particular, who are feeling the pain of the disgraceful way that general practice has been treated over the past ten years. I believe that the unconditional support of a determined outsider working ‘inside’ may be exactly what general practice and the College need at this time.
Dr Michael Dixon is a GP in Devon, chair of the NHS Alliance and also sits on the board of NHS Clinical Commissioners.