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Our generals need to put on their helmets and join us at the front

There are too many ‘generals’ in primary care leaving the ‘grunts’ to do the fighting at the front, warns GP Survival chair Dr Alan Woodall 

Dr Alan Woodall

We all have our hobbies to take away the strains of work. I’m a bit of a military history buff, and one book I read recently noted that in the Second World War, for every one US soldier who fought in combat (the ‘teeth’), six were involved in the logistics (‘the tail’) – supplying the ammo, food, pay and so on. By the time of the Vietnam war, that ratio was 1:17, if I recall correctly.

Something similar seems to be happening in primary care. Over the past decade, there seems to have been an explosion of clinical advisors, co-ordinators, leads, ‘champions’, experts and managers. Everyone and their uncle seems to be on some ‘leadership course’ despite having no experience of the actual job of being a GP.

Many of these roles are completely non-clinical, meaning clinical staff now spend their days behind a desk, rarely seeing patients. I include in this group many GP hours siphoned off for work as appraisers, course-organisers, clinical leads of this or that initiative, or sitting on CCGs or health boards. All these roles need doing, but they are the tail not the teeth of primary care.

Meanwhile, we can’t staff our frontline primary care services. Our local community hospital can’t find a doctor to deliver care to it – they are now desperate for GPs to take this on. And forget finding a locum at short notice. Yet committee meetings are full of GPs designing pathways, auditing performance, and generally making life for the troops at the frontline more rather than less onerous while fewer of us do the actual fighting.

We have too many managers in the tail, away from the fighting, telling the depleted, exhausted frontline troops we must do more  

I’m reminded of a couple of classic lines from Blackadder Goes Forth, where Baldrick is told before he is to ‘go over the top’, ‘don’t worry my boy, if you should falter, General Melchett is behind you’.

‘About 35 miles behind you,’ was the retort. And yet, again and again, I find I’m exhorted by the general staff to make ‘one more big push to move General Haig’s drinks cabinet six inches closer to Berlin’.

It is beginning to feel like ‘us and them’. There are too many clinicians and managers in the tail, away from the fighting, telling the depleted, exhausted frontline troops we must do more with less, do better with fewer supplies, and that our sacrifice is worth it, while they enjoy their ‘filet mignons in a sauce bernaise’ back at staff HQ.

We need to give the medals and the best ration packs to the grunts doing the fighting, and ensure those generals put their steel helmets on and share the burden of fighting.

Dr Alan Woodall is chair of GP Survival


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Readers' comments (11)

  • Lions lead by donkeys as it always was.

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  • well said

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  • Known as REMF's - Rear echelon mother**ckers

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  • Agree. Particularly bemused by all the Trainee/Registrar/FirstFive spending time at Leadership courses. Surely a little bit of experience of front line before you become an advisor to those who’ve been doing it for years.

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  • Well said
    I am frequently appraised by retired Drs
    There should be a minimum front line clinical commitment for anyone applying for a leadership role that requires a degree in Medicine

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  • One is reminded of the Duke of Plaza Toro in 'The Mikado' - 'He led his soldiers from behind, he found it less exciting'

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  • I can think of a few who are in non-clinical roles because they were "promoted out of harm's way". Not sure I want them getting under my feet in the trenches.

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  • Took Early Retirement

    GP Survival: I think that's the rather ineffectual FB group isn't it? More hot air. "Full of sound and fury, signifying nothing".

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  • Military Police has one of the lowest death rates in combat. Those of our colleagues who are currently policing us are the most likely to survive the current blitz on general practice. Let's face it, they are smarter than us.

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  • Im sure Dr Madan, Steve Field, HSL and all the rest are quite happy where they are.... I dont see them ever doing anything to help the troops, just themselves..... They're not smarter, just more exploitive, with their efforts spent on climbing the greasy pole, not helping patients, and want to avoid any hard work that might incur themselves some risk..... its like the 'Emporer's new clothes' every time they make a statement, only in this case we can all see the truth, and its not a pretty site, its no wonder they don't enjoy much respect outside their own organisations,only they dont listen to any 'anonymous' / critical observations hence they subject themselves to feedback bias so its no wonder they think they are great. Unfortunately the analogy with Blackadder is spot on. Our so called leaders - aka the 'Top London GP' self promoting, 'because we're worth it' clique is one of the reasons general practice in the UK is in a mess and the biggest reason why the front line troops wont ever be let out of the trenches. Unfortunately this 'war' wont ever be over, but at least you can't get shot for deserting the trenches, nor the RCGP. A mass desertion is whats needed to bring the generals down. Emigrate, retire or retrain, but the troops need to stop propping these self promoting idiots up. If they'd brought us a statute of limitations, state indemnity or anything other than a colouring book and a bunch of c**P about resilience training I might have some respect for them.......

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