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CAMHS won't see you now

General practice is burning, but I refuse to lose all hope

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Copperfield called hospital consultants ‘white coat mentalists’. I laughed out loud. I read his recent pieces about the implosion of general practice and also Phil Peverley about his recent illness. I respect these guys, their pain is all our pain. Their rage is tangible, but far worse is the hopelessness.

I did general practice because I didn’t fit in the hospitals, not because I was stupid. But I was always branded a ‘failed consultant’ and the patronising tone of every medical SHO still echoes in my head.

I believe there is a solution

Also we had children in my 20s and we needed to settle down. Gender stereotypes are a two-way street. I loved my family and my role was as provider and I have worked full time for over 20 years because I had no choice, life-work balance hadn’t been invented back then.

I found I was a square peg in a square hole in the Glasgow inner city. General practice was full of bright and able doctors. I work countless evenings and overnights too; jumping puddles in the dark, taking piss stained lifts up the tower blocks, to see dying people at 3am with a small bag of largely useless medications. A relentless volume of work and decision making that unless you have experienced it, is beyond comprehension.

There is no situation in medicine that I have not endured, some so traumatic that I actively try to forget. I took daily anxiety induced chest pain as a norm for years. I accepted this all, for general practice is the most important of work and it was my vocation.

Why is general practice in crisis now? It is certainly political. Opening some new hospital was always more headline grabbing than investing in more health visitors. All politicians are more impressed by a bow-tied-oxbridge-academic than some Sunderland or Essex GP (who actually did the job but no one ever asked their opinion).

Successive governments were seduced into more money for hospitals, and worse still, more money for ill-conceived public awareness campaigns that jet propelled public health anxiety. The ‘expert’ always on hand to criticise GPs for a supposed lack of knowledge and delays in referrals. This didn’t just happen once, but relentlessly for decades, constantly undermining the position of GPs. We were forced to refer even when we knew it was bullshit. The hospital system is dysfunctional, inefficient and offers appalling service but gobbles up 90% of all resources. Even if you try, a consultant will never phone you back.

The media did the same, took an isolated case that was emotionally charged to chastise GPs. The GP had no opportunity to respond and balance doesn’t sell newspapers. The Daily Mail was toxic. They presented as fat cats, but seem blind to the private income of consultants. Our supposed protectors, like the Guardian newspaper and the BMA, and others (I’m looking at you GMC) stabbed us in the back by offering their staff private health insurance. The establishment patronises GPs and is too good to see a GP themselves. They actively undermined the ‘my doctor’ GP that most ordinary people greatly valued.

Working GPs are excluded from the selection and training of doctors. The hospital guys and academics only choose people in their own image, so medicine remains the least social diverse profession of all. GPs are relentlessly denigrated by many hospital colleagues. The shrill denials are of course a case of ‘the consultants doth protest too much, methinks’. GPs are tired of this crap. 

Finally, there is a spectacular inability by the establishment to understand that most people are well, not ill. And protecting this wellness is the real role of medicine, not trying to save us from the inevitability of death. GPs are protecting the British population from the international insanity of modern for-profit health care. Look no further than the USA to witness the iatrogenic murdering harm that medicine can do. We have saved the NHS hundreds of billions of pounds, but no one seems to appreciate, acknowledge or even notice our success.

So now many GPs are soon to retire, the last of the chino rationalists. And no amount of new financial corn will keep them working, they can’t stomach anymore scorn. They are off. They are the glue and the system will fall apart. And our medical institutions offer no solutions, for they couldn’t organise a ‘cheese and wine’ in a winery. But I will hold onto the burning match that is general practice in my finger nails as long as I can.  I won’t let hopelessness consume me, for I believe there is a solution

This is the first of a two-part blog from Dr Des Spence as part of our ‘Great GP Debate’ season. Read the second part here. If you would like to write a blog on how you see the future of general practice, then please email the Editor at

Dr Des Spence is a GP in Maryhill, Glasgow, and a tutor at the University of Glasgow

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Readers' comments (20)

  • Excellent analysis of the situation, well written.

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  • Spot on, and yet the optimism is wrong, I see gp disappearing down the rabbit hole to be replaced by corporate primary care, the family doctor is no more and we are seeing the genesis of production line primary care just now with target driven medicine foremost in hmg sights. So very sad!

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  • As a hospital 'mentalist' I gave this 5 stars. As to the note of optimism at the end - I await the second instalment with baited breath.

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  • To us in NI it is crystal clear.
    The DOH has cut funding to General practice by 50% in 11 years from 11 to 5.5%. That is self evident murder of GP land. Optimism is good, but in the face of a 50% cut, maybe not logical.
    During this period consultation rates are up over 60%. AND we GPs here see 90% of all consultations on 5.5%.
    Good for Des to be optimistic.
    I just present the facts.

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  • Hi Des, I as you know am no stranger to jumping puddles, and disgusting lifts at 3 am in tower blocks.

    I have just retired aged 58, agree with all views including no monies could bring me back to work in this toxic environment.

    Glad you are an optimist!!!

    Best Wishes,


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  • Brilliantly written, I share your outrage.

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  • optimism -from my dictionary :-

    a severe mental derangement , esp when resulting in delusions and loss of contact with external reality . [ Greek -generalpraktikolos]

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  • Good stuff Des.
    I hope you haven't set tourself up to fail with this optimism thing though.

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  • AlanAlmond

    Well written, wide ranging and exactly as it is.
    Could do with being read more widley than just PULSE subscribers

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  • Interesting piece, with some salient points. I regard myself as an optimist in possession of the facts which is a working definition of pessimism.
    I'm struggling to comprehend the cognitive dissonance expressed above when the writer calls himself a square peg in a square hole and then parades his 'martyrdom for the cause' by accepting the anxiety and chest pain it bestows upon him.And then calls himself an optimist?

    Perhaps he should se a doctor; that burning match he holds so tightly makes me wonder if he has a peripheral neuropathy.

    He also reinforces the very real divide between primary and secondary care; having spent a significant time working in both environments my impression of the average GPs prowess in 'doing medicine' is not especially favourable.Having said that, with the trend towards specialisation in secondary care particularly in the last decade (give or take a few years) the prowess of these self-avowed specialists to even consider an aspect of a case which by rights they should have the ability to address and interpret has also become quite pitiful.

    The tl/dr version -its all f.^ked and I cannot see this trend being reversed any time soon.

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