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At the heart of general practice since 1960

Don’t write off Generation Y just yet

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I’ve been informed on a number of occasions that the best way of achieving quality improvement is to think about stuff that is an irritant. Well, I’ve been increasingly irritated by the preconceived notions of many older GPs about younger GPs.

‘None of them want to be partners,’ they say, or: ‘They just want to clock on and clock off.’

Instead of denigrating our trainees we should turn to them

So I decided to find out what Generation Y really want for their future and organised a conference for Bristol GP trainees. We invited local GP leaders and our keynote speaker was former RCGP president Sir Denis Pereira Gray, who was the highlight of the day. Free from any PowerPoint crutch, he talked for more than an hour about the core values of general practice. He was the perfect panacea for the general pessimism after trainees heard about the triad of crises: funding, workforce and demand.

We were moved and inspired by the narrative of what it meant to be a GP in the world of Sir Denis. Coming from a dynasty of GPs, he told tales of patient poverty from his grandfather’s days, of the dawn of the NHS from his father’s days and of GP empowerment from his own career. He is justifiably passionate about research, but not the type that tells you which ß-blocker to prescribe. It is the type that has been swept under the carpet by policymakers because it is an inconvenient truth hindering their preferred direction of travel.

Sir Denis’s evidence confirms the central role of continuity of care – not only its association with reduced referrals and admissions, but also with increasing patient compliance and reducing mortality. He described it as a ‘wonder drug’, which, if marketed, could earn millions for a drug company, yet somehow it is not approved by the Government. Which other drug with these properties would be denied the chance to get on the market?

He had a profound impact on trainees, who were already cynical about their role in the brave new world of Skype consultations and conducting an ‘orchestra’ of other healthcare professionals. The climax of the day was a Question Time-type panel, with a final vote on trainees’ appetite for GP partnership. To our shock, there was overwhelming support for a partnership role at some stage in their careers – but not in the current climate.

A follow-up survey of trainees confirmed this aspiration. It also asked about priorities for work, and the results will come as a surprise to many.  A good team and continuity of care ranked far higher than income and working to rule. Seeing patients face to face in one base, ranked far higher than working from home or patient demographic. And because more than 90% of trainees see general practice as unsustainable within the current funding envelope, over half support alternative funding models.

So there we have it. A new generation of GPs whose values are not too dissimilar to ours. They value worklife balance, but retain the aspirations of continuity, teamwork and high quality of care. 

So instead of denigrating our trainees in our most desperate hour we should turn to them. For they are our only hope.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (13)

  • Mr Mephisto

    Well done. Have you any plans to take the show "on the road" to other regions?

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  • Azeem Majeed

    Thank you for your article Shaba.

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  • I'd love to be a partner in my own practice, developing continuity of care with my patients. But when I've seen excellent GPs I know having breakdowns and going off work with stress I choose to practice as a locum. Doesn't matter if I need to spend extra time with a patient, I've no beurocracy to deal with after clinic. I hope things change so it becomes a viable option again.

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  • Shaba;
    You are not a partner,nor Dr Grey,nor the trainees,nor do the trainees intend to become partners,yet all are agreed what a rich rewarding experience it is.
    About 80,000 youngsters aspire to medicine annually,800,000 in any ten year period,yet ten years later,many partnerships would not attract a single applicant
    Someone somewhere in the medical training hierarchy is doing a fabulous job eradicating GP's
    I think it would be more productive to facilitate trainees aspirations to alternative funding models,beginning with examining how they can eradicate those who oppose them

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  • It's clear why partnerships are not being taken up. There is too much financial uncertainty. No one knows even if the practice will turn a profit in 5 years time so how do u expect young GPs with mortgages and young children to take on this risk? The older GPs should look at themselves to see how they allowed their profession to fall into this mess.

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  • GPs who started in the 20th Century dreamt of and competed for a partnership - a job for life, guaranteed decent income, a chance to shape your own future, be your own boss, own your workplace, enjoy continuity of care, work in a team, become a pillar of the local community, the prospect of doing the same job for 30 -40 years until retirement.

    Of course, these dreams were shattered after 2010, leading the nightmares of unlimited liability, last man standing, insatiable patient demand, the pointless interference and ball ache of CQC/med mgmt/appraisal/CCG, profit erosion, shrinking pensions and a constant creeping dread of the next horror coming down the pipe (hello 7 day opening).

    GPs starting in the 21st Century know this. They (quite rightly) want freedom, portfolio careers, time flexibility, family life etc, and a partnership working all hours and carrying massive liability scares them off. Besides, the pay gap between salaried and partners is reaching parity..

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  • Generation Y keep away from partnerships,A financial millstone around your neck.In time of uncertainty you need to be flexible, no be bankrupted when your practice collapses under the regulatory burden and the pressures of a massive workforce crisis.Primary care is not valued.We are expected to serve a penance like naughty children when the parent has made the mistake of very poor planning in provision and workforce.When asked to jump, we are expected to ask how high.This is a poisonous little country with a poisonous small minded government.Keep away look after your self and your loved ones.We are in a global market.And despite what the government tries to do market forced reign.Value yourselves, control your destiny.This cannot happen when you commit your self the the current model with the current underfunding.The current alternative offered are likely to be no better if not worse.A sad state of affairs to a once noble profession.

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  • Its not generation Y that should be written off its the NHS, the UK and the previous generations that have allowed this to happen.We should be written off by generation Y.Can they forgive us,I know I wouldn't.

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  • Vinci Ho

    You probably know where I stand for partnership, continuity and younger generation(s).
    The real question here is , however , what is the latest definition of a GP partner in this system which has been seriously damaged by our common enemy? What will we do to preserve the telos of general practice we have long served or is it really inevitable that this old purpose had to be scrapped altogether?
    For those young colleagues who are presented in front of them opportunities to become partners , I suppose you may share the feeling of David Milliband about 'coming out' again,"It's hard to see, but what is the point of saying never?''


    ''Arguments about justice and rights are often arguments about the purpose, or telos, of a social institution, which in turn reflect competing notions of the virtues the institution should reward and honour .''
    Michael J Sandel

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  • Pev has defined it. The bureaucracy, last man standing, prospect of bankruptcy, the fall in profit per consultation of 50% in 10 years etc is driving senior GPs away. I do not blame young GPs for not joining something the older ones are leaving en masse. They can see there must be a major problem, if people like Pev and yourself leave.

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