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How to give GPs a happier New Year

Editors’ blog

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If I could sum up the feelings of most GPs I have met over the past year in one word, it would be ‘frustration’. The profession feels that it is being failed by an establishment that does not understand (or wish to understand) the depth of the problems in general practice.

Take the biggest event of the year – the announcement of a ‘state-backed’ indemnity scheme to ‘stabilise’ costs for GPs in England by health secretary Jeremy Hunt at the RCGP Conference in Liverpool.

In usual times, this kind of announcement would be met with unqualified delight. But the response I observed both inside and outside the hall was undisguised suspicion. One questioner asked – to Mr Hunt’s visible discomfort  – why after so many warnings is the Government only acting now. ‘Why should GPs believe what you are saying today?’ she asked.

Of course, this distrust does vary across the country. In Scotland, GPs are looking at a new contract that will have them working much closer with the rest of the NHS, whereas in Northern Ireland they are busy collecting resignation letters. Across England too, there are varying degrees of happiness in terms of the outputs of the GP Forward View. Many do not see any difference, others are observing promising change.

Words about how important general practice is are undermined by piling more work onto the profession

Perhaps I should be more generous to the ‘powers that be’, given that they are trying to turn around a situation that they have inherited without being given adequate resources to do it. But this is not all about money. It is about will and a change in the attitude that the health service has towards general practice.

Words about how important general practice is are undermined by – sometimes in the same breath – piling more work onto the profession. The health service should challenge the assumption that ‘business as usual’ is acceptable when patients are waiting up to three weeks for an appointment and practices are closing. It should admit that offering a pharmacist or a physician associate is not enough, when a fully trained GP is needed. It should threaten Capita with the cancellation of its contract unless its performance improves – and fast. And it should not give the green light to disruptive ‘innovations’ which undermine long-held principles of general practice.

Why? Because the current level of unhappiness in the profession is crucially important. One of the other big news stories of the year was the  continued struggle of the authorities to reverse a decline GP numbers  – despite promising 5,000 more by 2020. The current solution is to import 2-3,000 of them from Europe, although that will help, it will not fix the problem.

A permanent solution is to make the job bearable again. Chuck out all the things that GPs do where there is no evidence that they improve patient care and encourage those that do. I am sure your average GP could come up with a list, but here are a few ideas from me: review revalidation, chuck out CQC inspections (except for the most risky) and put seven-day access on hold.

Doing these things would cost nothing, and they might just convince a few thousand GPs not to retire, reduce their hours or resign their contract. We are about to enter a new year, and there is still time to make it a happier one for GPs and the health service which relies on them.

A very Merry Christmas from myself and all of the Pulse team.

Nigel Praities is editor of Pulse. You can follow him on Twitter @nigelpraities




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Readers' comments (8)

  • Agree aith all else,I think you are being a little generous in one of your paragraphs Nigel. The Government did not inherit a mess in the NHS. But they have cruelly and deliberately created one.
    In Tory's eyes Mid staffs was an amateur job.

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  • Interesting thoughts based upon the premise that the government is in control,has a grip, and is making proactive plans.
    I would propose that it is not.
    The government I suggest, is firefighting,responding to crises retrospectively. Of course if you accept this,the idea of a BMA negotiating a future contract becomes farcical.
    Until the public pressurise their representatives, there is no imperative for government to do anything.
    The strange thing is that at present other than persistent grumbling, the public generally do not act.
    There are no public demonstrations, no mass rallies,no evidence of the public registering that the situation is unacceptable.
    The public are largely disinterested because the reality of the situation is not made clear to them.Endless BBC soaps perpetuate the fantasy,nobody actually comes to harm in the end.
    Only the electorate can influence government,and they will only do so if they understand how the crisis effects them personally

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    Unfortunately it is only appreciated once it is gone .. like NHS Dentistry

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  • Healthy Cynic

    More ideas:
    Scrap the 'frailty index', retire the 'Friends and Family test', remove all care home work from GPs, remove the processing of repeat prescriptions and most letters from GPs, scrap large chunks of the QOF (annual asthma check, RA review etc).
    Let increased patient access mean 'getting an appointment during the day' rather than stretching the day into evenings and weekends.
    Make 'working at scale' no more than an option, and encourage the 'cornershop model' of general practice.

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  • not the f word i would use mate

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  • It is the Primary care "management class" that have created this current climate - basically bolstering their own position and power-base whilst bossing frontline clinicians around without taking any of the risks...unfortunately quite a lot of GPs have "gone native" with the managers - patient avoidance taken to extremes :-)

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  • A long time ago (before my horrendous ridiculous unnecessary GMC trial after which I retired due to the terror of it being repeated as they clearly do it for any old frivolous reason) I was a GP in the nineties. We went in at 9am, saw ten patients, did a couple of House calls. Then we went home for lunch or God forbid, we’re taken for lunch by drug reps. We then came back at four and spent another two hours seeing patients. Admittedly one person in the practice was on call all afternoon and we took it in turns to do nights and weekends which were pretty awful. In those days we had to go see the person with chest pain before the ambulance or the breathless person and of course the person who had run out of tampons. But aside from the awful nights we were our own bosses, we seemed to be respected by most of the public and staff. There were no obvious managers although they were starting to creep in. And guess what - it was a pretty good job and we felt valued and generally quite happy.
    Management and endless rules and hoop jumping have made this a bad job and we let them do it. In fact lots of our own became these awful management rule makers. There is nothing so self important as a GP turned manager.

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  • Make public examples of managers making a mess of things, of hospital doctors who fail to take responsibility for issuing necessary prescriptions, 'Fit Notes', or fail to provide a discharge letter to the patient on discharge - even perhaps allow GPs to refuse to accept transfer of responsibility until we have received the discharge letter and approved the discharge; fine consultants and other hospital doctors who undermine our QOF scores or drug budget scores by prescribing inappropriately or uneccessarily expensive preparations -or at least make them write the prescriptions themselves; allow all Vision practices to migrate to EMIS by March (2018) at the latest; overhaul the MPTS and GMC procedures and composition; and remove most PCG/LHB managers and replace them with people who care about the NHS ideals. Oh, and while we are at it, replace the current health minister with someone who cares about the NHS (or indeed anything other than his own ego).

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