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At the heart of general practice since 1960

Demand for GP time will drown our profession

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It wasn’t until halfway through the afternoon session that I had to move the toy box, kindly put there by the cleaners, from off my examining couch, in order to lay my hand on someone’s abdomen. That day I may have used my stethoscope three times and my otoscope a few times more.

So what do I spend my time doing?

Debating with a patient whether I should write a letter for the council to state that he was disabled, so he could get a lift put into his house for free; doing extension of sick notes for patients that normally see my colleagues who were on holiday; listening to patients grieving for their recently deceased relatives. I’m sure there were flotsam and jetsam of actual medical decisions to make, amongst the flood of other things.

It seems to me that the dam of common sense, self care and community-based wisdom has developed irreparable cracks - perhaps even crumbled away in places. The reservoir of human need that has previously been held back, is now starting to flood primary care, with nothing to stand in its way. The snowmelt of screening, media scare stories and the mentality that ‘you can’t be too careful or catch something too early’ would swell the reservoir, even if the dam wasn’t bursting. The waters keep rising.

At some point I’m going to run out of fingers to stick into the dam, or run out of individual advice and education for my patients. I shall have to run for the hills, moving to higher ground or clamber into a lifeboat and set sail for warmer shores. The waters keep rising.

Others are trying to redirect the flow of need to the other more appropriate streams of social care, pharmacy and family. Some of my colleagues are already drowning in need, others are slipping and sliding in the resultant muddy mess around them. The waters keep on rising. 

Dr Samir Dawlatly is secretary of the RCGP’s adolescent health group and a GP in Birmingham. 

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Readers' comments (8)

  • Azeem Majeed

    We do need to look at skill-mix in primary care and ensure that GPs' time is used appropriately. We also need to encourage more self-care and make patients more responsible for their health and the management of their medical problems.

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  • dear Azeem. I have been doing precisely that for the last 15 years as a partner to no avail. Education does not work when the media and the government stokes up expectations. Skill mix. Done that with ANP s and CNPs etc. Does help but only for a while till thinks catch up again. With the latter you end up dealing with draining complex cases in "10" minutes and no quick breather pill checks. Not sustainable long term. Education or self management only works if there is a fee attached to the alternative. If it hits you in the pocket, you will try and do it yourself. If you increase your access and availability, then the patients are going to suck you dry. And on the downside patients with REAL clinical need suffer as they can't get timely access.

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  • I think we are well passed drowning.... we are pulling bodies out of the water.

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  • Ivan Benett

    Time to end the independent contractor status and fully Nationalise the NHS. That way we employ GPs to do General Practice and employ managers to manage, Health Promotion people to health promote, nurses to nurse. We can develop a career structure so GP who want to develop an extra skill (e.g. cardiology, like me) can do so. Share expertise within a locality.
    Becoming a salaried GP has liberated me from all the administrative weight and allowing me to swim - against the tide sometimes. Read my manisfesto for General Practice

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  • Dear Ivan Being a locum has liberated me and no way will become salaried GP to be bullied by managers and politicians who have no clue to what 's going on ,do same as partner for less money even if means emigrating or leaving the profession. Nationalizing in Tory world would mean privatisation. The equations are very simple.

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  • This is what modern general practice has become.We are a dumping ground;society's anal canal dealing with all the refuse.From time to time you do come across some real juicy cases which reminds you why you went into medicine in the first place but that is rare.I always advise junior doctors to go into hospital medicine if they want to practice "real" medicine.

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  • @Ivan - in the same way presumably you'd stop GP's involvement in CCGs to get them back to doing what we trained for. I wouldn't argue with this

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  • "I always advise junior doctors to go into hospital medicine if they want to practice "real" medicine."

    These comments are so sad. What do you really think medicine is about? Diseases and pathology? Doctors with these attitudes would be better off working in a lab than patient-facing.

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