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At the heart of general practice since 1960

I worry that 'micromanaged' GPs will simply walk away from the NHS

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This morning, my contribution to the sum of human happiness was to ask almost every patient if they would mind answering a few questions on their exercise habits, and to categorise them accordingly.

This is, of course, part of the new QOF initiative to see how much harassment you can impose on a hypertensive patient before they get fed up and stop coming to their annual reviews.

From the patients’ perspective, it must be a boon to those who missed paternalism and having value judgments passed on their lifestyle. From our viewpoint, it’s simply another ball that has to be juggled, along with smoking status and the reason the patient actually booked an appointment.

I recently had an email conversation with a friend connected to the Department of Health, in which I tried to explain why these incremental additions to our workload are finally reaching saturation. And the point I keep coming back to is that, if it all goes wrong, the GP is still nominally the one in control.

If the consultation is mismanaged – if you miss something terrible – and someone is hurt or killed as a result, you are as much to blame as you ever were. Never mind that you were distracted by shoehorning half-a-dozen irrelevancies into each consultation. Never mind that you are under constant pressure to reduce your referrals. If something goes wrong, you still carry the can, both morally and legally.

We all accept that this is a job that carries responsibilities. We all feel an obligation to do the most we can for the person in front of us, and a lot of doctors will have suffered sleepless nights when they thought they’d got it wrong. We deal with this responsibility, accepting it as what we were trained for and what we are paid for.

But the other side of this covenant is that we have to be given the freedom to do this difficult, varied, and fascinating job to the best of our ability.

An ever-increasing amount of our time is taken up by things that are not on our patients’ agenda, or on ours. We have to see a rearrangement of priorities. If the threatened mass retirements do take place, remote micromanagement will have played a large part.

If the lights are switched off for general practice, they will have been switched off by remote control.

Dr Nick Ramscar is a GP in Bracknell, Berkshire

Readers' comments (7)

  • By the time I finished working in general practice in the UK, I had realised that it was impossible to fit in the patient's agenda as well as QOF (and QOF plus in our PCT) in a 10 minute consult. I now have the luxury of 15 minute consults, which allows a much deeper exploration of the patient's concerns, and hopefully better outcomes, less medicolegal risk etc. also seeing few patients in the same working hours means less risk of burnout. GP in Australia isn't perfect, but for me it's not far off.

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  • You are right. The irrelevant demands of QoF, shoved into a 10 minute consultation required a shorter time to be spent on the patient's agenda. I am certain this will lead to more complaints from patients that they are not being listened to, and in some cases mistakes made by doctors who do not listen.
    For this reason I feel that I can no longer perform to the best of my ability and have decided to add to the numbers leaving early.
    Yes, there really is an actual exodus and its happening in a town near you now!

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  • Odd- We are independant contractors in the land of GMS - in other words private providers- and we behave like salaried staff meekly asking 'how high' when told to jump and then going off in hissy fits when our legs are taken out from under us. Pathetic!
    We have been pathetic, our representatives have been pathetic and we deserve everything we get for it. In retirement either stand in line in the NHS queue to tell 'them' how active we are, etc or get financially screwed by private health insurnace. Yup, don't dare look at the emperor's clothes. You are also a patient or a prospective patient and there are lots of people ready to fight for your rights there. Just won't be anyone capable or able to serve us our rights. Don't do anything about it now.............

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  • What worries Dr. Ramscar already happens in central London. My Polio specialist (the NHS hopes we will all die off soon so won't need one) has got so fed uo with the system he has gone private - and try to find a similar specialist n NHS - impossible. My Heamatologist is so fed up I go in as last appointment and spend 30 mins acting as listening post.; I reckon he deserves support.

    I fell very badly on scoliosis wracked spine - got osteoporitic squashed vertebrae - and had to pay to go privately to see pain specialist.; NHS said I couldn't see anyone until June, "but keep on taking the high-dose Tramadol". Luckily some patients aren't as stupid as they are - but you need your wits about you as a patient.

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  • Too much government interference + poor professional unity = poor morale...I've got 30 yrs left - I'm leaving the UK!

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  • Alison Glover

    If any decent GP is interested in wonderful general practice in New Zealand,(15 min appointments) where we are just starting really on this quality framework, years behind the UK for sure. Give me a call, we are keen on a new staff doctor with a view.... +64 21 2637979

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  • We are leaving the UK, There are many like me leaving the Uk! Purely due to bureaucracy and stress.. I hope Geramy will see all the patients....

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