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At the heart of general practice since 1960

Divided we fall – the impact of the ‘GP fat cat’ myth on NHS solidarity

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After yet another week that has seen the newspapers bulging with GP-bashing stories, it’s not the mainstream media articles that hurt. The picture painted of general practice is so comically different from the reality that you quickly stop trying to reconcile the two, and decide they must be describing some other job entirely. It’s numbingly boring, rather than hurtful, to see them rail against the tedious straw man of a golf-playing GP who bins tenners because they’re not worth the bother of carrying.

What is depressing, and deeply damaging, is to think that other doctors might for a moment believe in this grotesque caricature. Speaking to hospital colleagues, it seems that some have bought into the divide and conquer tactics, and think GPs aren’t working hard. If it was ever true, the view of general practice as an easy option is so far out of date as to be a myth. GPs are routinely putting in 12 hours of clinical work a day (often more) with partners fitting practice business in at the beginning or the end. Adding any more hours to this would take an already dangerous workload to critical mass.

As well as the sheer burden of time at the coalface, there is the curious, insidious intensity of general practice workload. We don’t have the dramatic support of a crash trolley, or the high-visibility heroism of a difficult intubation. What we have instead is the logical and methodical balancing of risk, ofteninformed only by our own clinical skills and ability to listen.

I believe that we are hobbled by the fact that, like any quiet skill, this can look easy if you’re not the one doing it. I can only think of one other scenario in medicine where a clinician takes sole, undiluted responsibility for a new patient every ten minutes, and continues to do so for unbroken hours at a stretch. That is the consultant post-take ward round. I wonder if they would consider it a cushy job, doing continuous post-take rounds with no juniors and precious few diagnostics. Especially if every aspect of the patient’s well-beingwas fair game: acute or chronic, across every medical specialty, and stretching deep into non-medical territory.

General practice can of course be hugely rewarding, and great fun. When it’s going well, and you have the time to do your job properly, there’s not much that can beat it. And if you’ll allow me to briefly clamber back onto a favourite hobbyhorse, the times I find most rewarding are when I’m able to catch a spiral of medicalisation at ground level. Transmogrifying a Google Melanoma into a mole, or revealing a slathering Internet Brain Tumour to be a tension headache in Halloween costume – these are the triumphs that we all relish. And sadly, they are all but invisible, because a satisfied, reassured patient never troubles the Emergency Department or the in-patient wards.

I don’t believe that we necessarily have it any harder or easier than other areas of medicine. Every clinician is feeling the heat. But we mustn’t allow the fatal mistake of having wedges driven between us. It’s easy to believe, when you are exhausted and demoralised, that somebody else must be slacking. But hospital colleagues must avoid the trap of blaming GPs for their troubles. As Professor Gerada says, we are one NHS. United, we may yet stand. Divided, we can do nothing but fall.

Dr Nick Ramscar is a GP in Bracknell, Berkshire.

 

Readers' comments (35)

  • Absolutely. And likewise, do not fall into the trap of thinking your job is uniquely stressful.

    EAU and ED doctors also take sole responsibility for the patients they see every ten minutes during the whole of their shifts - and that's not just a three hour surgery. Don't think that responsibility ends with the outpatient clinic or the ward round - the results, letters, phone calls and admin are endless.

    The endless hospital bashing about how we kill hundreds of patients every time we step through the door is utterly demoralising, as its the constant misguided rhetoric that it would all magically be better 'done in the community' and that we are all dinosaurs waiting for extinction ... at the same time as we are bashed for our waiting times.

    Lets give each other a break and fight the common cause. It's medical burnout, not just in GPs, that is the issue, caused by rising demand, political meddling, constant reorganisation, lack of support and funding constraints

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  • Its hard to take this seriously when pulse publish articles about changes in tax status that only affect those earning more than £150k pa.and how that will affect lots of GP's

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  • 12:24 - As a full-time GP I could only dream of earning £150,000. I am now earning less than I was in 2004 and at the rate things are going will shortly be earning less than most advertised salaried jobs. Get your facts right before writing pointless comments on this forum.

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  • 'This comment has been edited by the moderator'
    What makes general practice difficult is coping with the incessant patient demand NOT the actual cases you see.Hospital doctors on the other hand deal with a much sicker population and require a far higher level of clinical acumen.So are GPs overpaid and underqualified?..you betcha!!

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  • 12:59
    More ignorance and lack of understanding!
    Must try harder.

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  • well based on these comments we are divided!!

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  • Cannot believe some of these comments. Both GPs and Hospital clinicians try to do their best for patients, often in difficult situations. Of course these differ - GPs never know what will come through the door next whilst a surgical clinic is less likely to be so varied, but the work is still just as pressing. I have immense respect for my hospital colleagues and, having just done my 360 feedback, seem to be appreciated back. We all earn more than the average wage and I think we deserve it. Why else do we pick the brightest students to study medicine.

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  • We are a divided profession, we are divided by what unites us.... the ever growing massive workload and a desire to do our best. When you are working so hard it is difficult to see how hard others are working but all to easy to blame.

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  • Unqualified 'workers' in the financial sector are given (they don't earn them) massive bonuses for shuffling pieces of paper regardless of profits and have brought the major economies of the world to their knees. Doctors spend years qualifying and then have to keep their skills up to date, first sign of an error and they can be barred from practice. What an insane society where people who do good are castigated for wanting a reasonable income and city leeches who cause untold financial harm to us all are held up as examples of what we should aspire to.

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  • I do see small number of senior consultants who actually understands General practice, and they are often apologetic about how ignorant their colleagues are. I won't pretend to know all about secondary care but I have enough about it, and have enough friends to know they make judgements on GPs without having full understanding.

    I also know from my GP partner whose spouse is a consultant cardiac surgeon, our income is about 2/3 of his NHS income - and we work about 10hrs more/week.

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