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Gold, incentives and meh

Are you a proper doctor?

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The opening paragraph of a Telegraph article said: ‘A new contract for GPs will see the return of ‘proper family doctors’ responsible for round the clock care and dedicated help for the elderly’. I immediately felt anxious.

Our coalition government feels they need to sort out the crisis affecting A&E departments. GPs are being blamed for this crisis. We are allegedly the reason frail elderly patients are clogging up A&Es and blocking beds on wards. Of course it’s not down to the loss of extended families that care for their elders, complex health needs of an increasingly aged population with insufficient health resources and the lack or inadequacy of care services.

The Health Secretary and the BMA have thrashed out a new GP contract which promises: ‘same day access to doctors via telephone consultations and personalised care plans for the frail and elderly’. This is a coup for the coalition government which feels the 2004 contract agreed by the previous Labour government is the reason we’re in this apparent mess.

Have I missed something here? Don’t all practices up and down the country offer a same day service via telephone consultations? I do distinctly remember a delirious day as the duty doctor last winter where I may have said: ‘Hello my name is Dr Chakrabarti, I’m ringing from Surgery X, how may I help you’ about 70 times. I and many of my colleagues saw some of those callers that day. What else is Mr Hunt hoping we can do?

Knowing and caring for elderly patients is something I do presently, even as a locum. I understand that there is a cohort of the particularly frail and vulnerable (2% apparently) which unfortunately do end up being admitted acutely and subsequently experience morbidity and mortality from a probable unnecessary admission. I don’t mind being involved in co-ordinating their care, but what I’m not so keen on is the round-the-clock care that has been mentioned.

My father experienced the pre-2004 system. He was the friendly, hardworking, single handed family doctor and his patients were able to call him whenever they needed him. He had a pager at home and got paged at all times of the day and night. If it had been a particularly busy night he would come back bleary eyed and tired and then set off to work. It was quite normal for us not to see him much when we were growing up. Then in 2004, I noticed that he was home more and this was down to the new contract. I don’t think that GPs opting out of out-of-hours is the cause of the A&E crisis, but I do feel that the changes in GP-ing in the last 5-10 years has led to a disconnect between patients and doctors. A lot of this has been due to the mountain of bureaucracy which has taken GPs focus away from what they trained to do in the first place. The new GP landscape now has commissioning, CCG work and revalidation to further divert our attention. Also GPs nowadays want a work-life balance and are not prepared to work full time. Plus the workforce is increasingly female-centric. I am currently doing a maternity locum and there is a plethora of them to choose from.

With plans for named doctors, reinstatement of out-of-hours cover, seven-day care and the stresses of commissioning, there is a danger that general practice in the UK could become untenable and lead to a further exodus abroad.

GPs are sure getting a battering in the press, but on ground level, the patients I’ve looked after in the various practices I’ve worked in so far have been very understanding and appreciative about the service all GPs provide. ‘Don’t let the bastards grind you down’, said one elderly patient recently. I smiled and nodded. ‘Hello my name is Dr Chakrabarti, how can I help you…’

Readers' comments (7)

  • The UK offers the best out of hours service without going to ER in the developed world (69 % ) according to Nov edition of Atlantic magazine . It is delivered at low cost . You are unlikely to read this in a fascist rag like the Daily Snail. The above does not support the political agenda of privatising the NHS.

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  • Excellent blog - but don't be a martyr - LEAVE.

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  • You are not a proper doctor until you can order at least 10 tests for same episode of illness, preferably all at the same time. It does not need to be cost effetive or have any remote relevance to the symptom however.

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  • Re;"Proper Doctor's stay in Hospital Medicine".
    Mortality occurs highest in Hospitals , especially in August when new doctors come in under the tutelage of "proper doctors".

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  • You don't have to prove to anyone that you're a proper doctor.Only you know your true self-worth.However our critics might be forgiven for thinking that we're no longer practicing proper medicine when we're spending most of our time tick boxing through useless templates.Thus is the sad state of modern general practice and the reason why i advise all young doctors to keep to hospital medicine.

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  • I recognize a lot of what you say. However, General Practice is nothing like what it was 15 years ago when I did my VTS. Then it was a rewarding job to do, now we have become a profession of box tickers, referral refusers, blame takers and doctors who deal with the most complex problems in too short time and there is nothing on the horizon to change this. Even our own trade union the BMA is obsessed with managing public perception of doctors rather than supporting and fighting for normal GPs.
    As a trainer I feel sorry for every bright eyed ST coming through our practice.
    My advice would be- get out of the NHS, go to Oz or Canada or wherever if you want a good and fulfilled career. General Practice in the England is going to be a c*** job for the foreseeable future and looking at workload and intensity it's hard to see how anyone will be able to work full time to retirement.
    Leave now if you can!!!

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  • This is a well-written and accurate article, well done.

    It begs the questions in my opinion -- what can be done about the disconnect between grassroot GPs and their medico-political representation at the GPC, why does it seem that nobody is fighting on our behalf for reasonable resources and working conditions in primary care?

    Surely our representatives should keep plugging the simple point that resources for primary care provision have fallen very significantly as a percentage of the NHS budget, whilst workload has risen exponentially? Ultimately the primary care service (which is after all 90% of all patient contacts and therefore the backbone of the whole system) cannot continue with this unworkable formula.

    It will become extremely difficult if not impossible for GPs to deliver safe and effective patient care, despite their best efforts.

    In short it is either win-win for primary care and patients, or loose loose under the present political formula -- the primary care workforce will simply disappear and some alternative, I know not what, will replace it.

    It does cross my mind that in large parts of America, primary care provided by GPs has apparently ceased to exist -- I believe this gap in health care provision is where the nurse practitioner concept originated from - is this the future of primary care in the NHS as well?

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