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At the heart of general practice since 1960

The end of the affair

Bournemouth GP Dr Paul Barker on why a beautiful relationship has reached the end of the road

Bournemouth GP Dr Paul Barker on why a beautiful relationship has reached the end of the road

I'm troubled by my relationship. Random thoughts keep surfacing – how will I phrase them to cause the least hurt: ‘Perhaps the time has come to go our separate ways' or ‘we just don't understand each other any more'?

The divorce rate for doctors is about 40%, rising to nearly 60% if both parties are medically trained. But actually I'm thinking about my relationship with my PCT.

I've been a full-time GP for 10 years now, and the early days of our relationship started conventionally enough. I was courted by the chief executive, a brilliant woman with a deep understanding of health politics, and soon enough I became a member of the professional executive committee. Here I found like-minded individuals who cared enough to try to make a difference. The views of GPs were respected and shaped policy and strategy.

During this honeymoon period, we began plans for improving end-of-life care in Bournemouth and our first child was born, a brilliant, bouncing palliative-care team that continues to be a source of great joy to me. I felt confident the PCT's wonderful chief executive was capable of tough decisions that put primary care at their heart.

Our first tiff came with extended hours. In the middle of Dorset, little old ladies would take their seat at 8pm and grumpily say ‘can't see why I couldn't see you earlier'. Nor could I. We moaned and yelled and called all politicians urban-centric Etonians with a minor illness obsession. ‘You see, darling,' I would say, ‘we don't have commuters.' We relaxed and laughed and said how silly health policy was.

Soon after she left for new challenges, at a strategic level.

I kissed her goodbye and said I'd always be there for her. It was then the rot began to set in.

The PCT, now leaderless, began to implement health policy with little understanding of the GP day. Could they meet all four partners on a Monday morning at 9am? We thought this must be a joke. It wasn't. Strategic decisions were taken with little regard for patients or GPs, accompanied by a string of bureaucratic irrelevance. Every flu jab had to be accompanied by a raft of data, every minor surgery procedure by a 12-page form. In an attempt to justify positions, managers were dreaming up ever more dreary methods of data collection.

For me the sadness in the breakdown of this relationship, as I sit here unshaven and crying into a bottle of wine, is that it could have worked. I go along absolutely with the concept of auditing good practice and quite agree we should understand our efficiency as well as our clinical outcomes. But audit has been used as a punitive tool. And now, like all jilted lovers, I feel

I must make a prediction of my partner's doom – that the PCT will become irrelevant and will destroy itself.

This sadly leaves the door open for commissioner/ provider groups. Perhaps we could run some corporate speed-dating affair where prospective partners line up and we choose the most attractive.

But I don't want attractive, just someone with the same ambitions and outlook as me. So I guess for now I'll remain single.

'For me, the sadness in the breakdown of this relationship, as I sit here unshaven and crying into a bottle of wine, is that it could have worked' 'For me, the sadness in the breakdown of this relationship, as I sit here unshaven and crying into a bottle of wine, is that it could have worked'

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