This site is intended for health professionals only

At the heart of general practice since 1960

Senior partner's departure a sad sign of the times

A senior partner friend of The Jobbing Doctor is retiring after 30 years. That he is being replaced by a health care assistant, a physician's assistant and a few session of salaried doctor time is a sad indictment of the state of general practice.

A senior partner friend of The Jobbing Doctor is retiring after 30 years. That he is being replaced by a health care assistant, a physician's assistant and a few session of salaried doctor time is a sad indictment of the state of general practice.

How do you see yourself? Do you regard your role as pivotal, and without you your practice will be diminished?

I ask this because last night I was having a chat with an extremely good friend who is due to retire next year after over 30 years as a principal in General Practice. He has been a guiding light for his practice and a typical Jobbing GP.

His patients are very fond of him and so are his staff. As senior partner he may well be expected to set the agenda for his practice, so I was interested in the plans of the practice as to how they would cope after he had gone.

41227233I found it rather depressing and really confirms many young doctors' fears. They tell me when I teach them on the Vocational Training Scheme that there are jobs out there. But not many and not of the calibre of the jobs of those who are retiring.

You see, they are replacing him with a health care assistant, a physician's assistant and a few sessions of salaried doctor time. I suspect the amount that the practice will be spending on this process will be largely similar, and what they will be offering to their patients will be an increased number of appointments, but with people who are less qualified and will undoubtedly lack some of the skills, experience and ability of my friend.

This change has not developed in isolation. It is a direct result of forces outside of practices that are, either intentionally or unintentionally, conspiring to undermine the traditional model of general practice.

We are very much at the mercy of policy changes and over the last few years much policy has been designed with an explicit view to increase choice of providers, with words like ‘plurality' and ‘contestability' part of the armoury for dismantling the perceived monopoly of primary care.

I do not blame the practice: they are having to make commercial decisions in an increasingly uncertain future for general practice. The whole basis of general practice is being undermined by the use of ‘competition' as a driver to improve quality, as if it were like an unfettered market. It is not an unfettered market, it is indeed quite a regulated environment where the nostrums of capitalism should be secondary to developing a proper service.

We live with the law of unintended consequences. Much of Lord Darzi's review is based on quality and performance, and there is little to argue about in this. But his bone-headed allegiance to the policy of strongly subsidised polyclinics will damage general practice, increase the risk of multiple people treating an individual.

So, when I went out for an evening of playing chamber music with two young colleagues I used to teach and who are now at the start of a career in General Practice, I sought their views on what they saw as the usefulness and opportunities afforded by the soon-to-be-arriving Darzi polyclinics.

Their views were damning. They saw jobs in polyclinics as dumbed down and to be avoided at all costs. No future and only a temporary expedient (like out-of hours work or locum sessions) until a proper job came along.

They also stated that in the current economic climate, these heavily subsidised programmes were vulnerable to being shut down as soon as the politics changed. I was very surprised at the vehemence of their views, which will represent the future of general practice, and not the moaning of a tired old GP.

Then we spent the rest of the evening playing Corelli.

The Jobbing Doctor Recent posts

The unbearable weightiness of being a GP 11 May 09
Swine flu has triggered an epidemic of media hysteria 05 May 09
Margaret Haywood should have been praised, not pilloried 20 Apr 09
The three ages of general practice 15 Apr 09
Where are the decent GPs of the future? 06 April 09
Statistics may be dull, but they're key to the screening debate 30 Mar 09
Career fear the reason why no doctor blew the whistle on Mid Staffs 20 Mar 09
You don't fatten a pig by weighing it 16 Mar 09

Pull quote

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say