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Seven years in general practice – and four ways it has changed forever

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This was Steve’s last blog as editor of Pulse.

The farewells have been said, the bags have been packed, a rather dog-eared copy of the 2008 NHS Next Stage Review has been fished out from behind my desk. Today is my last day at Pulse - after seven years here, and two years as editor, I’m moving on, and on Monday the current deputy editor Nigel Praities steps in the hot seat.

What with my final editorial in the April magazine and the mention at the start of my last blog post, I feel like I’ve been saying a rather protracted goodbye to Pulse readers. And yet on my final afternoon, as I prepare to leave Pulse Towers for the final time, it seems worth a quick look back at the last seven years – and a look too at how general practice has been transformed over that period.

Superficially, of course, there is much that is the same. A profession wracked with low morale, a pay squeeze from the Government, worrying signs for practice funding and an ongoing struggle to engage GPs in commissioning; all these were true when I was a cub reporter back in early 2007. The Summary Care Record is still being rolled out, NHS IT chiefs are still trying to persuade practices to use Choose and Book. The so-called GP retirement timebomb is still ticking (although it seems, perhaps, to be getting a little louder…)

It’s tempting to suggest that GPs’ lot is much as it ever was (and, for that matter, this Pulse front page from 1970 talks of five-year training, polyclinics and named GPs, so maybe it is…). But since 2007 there really have been a number of fundamental changes which have forever altered the landscape of general practice. Here are four of mine to get you started.

  1. The rise of technology. No, not the Summary Care Record, or telehealth, or any centrally mandated NHS IT programme for that matter. Not yet. But like it or not, the advent of the internet and smartphones and all that that entails has fundamentally changed patients’ lives, and it is inevitably, inexorably, altering GPs’ working practices too. Jeremy Hunt’s ‘paperless NHS’ may sound clunky and five years behind the times, but like it or not change is coming. Seven years ago the idea of patients ‘rating’ their GPs online was anathema – now it’s common practice. Will the same be true for email and Skype consultations by 2020?
  2. Shifting goalposts on access. The big story in general practice in my first 12 months at Pulse was extended hours, and the Government’s attempt to make GPs work evening and weekends. It was a radical, incendiary move (there was even talk of GPs quitting the NHS en masse), and yet once it was forced through GPs grumbled but largely got on with it, forced to do so by the need to protect dwindling practice income. Access is big in the news again at the moment, with dire warnings from the RCGP, of all people, and calls for seven-day working – but the fact that we’re now talking about whether GPs should work Sundays rather than until 8pm on a weekday shows how the goalposts have shifted.
  3. The decline in BMA power. This one is linked to the above. The defeat over extended hours marked a new chapter in the relationship between GPs and the Government – after the threat of imposition caused the GPC to back down, ministers have been increasingly willing to bully in contract talks and Jeremy Hunt did in fact impose a very unfavourable deal in 2013. The real turning point was the disastrous pensions industrial action in the summer of 2012, however. For years the BMA had been keeping its powder dry. When it finally called a strike, and that call went largely unheeded, it lost (to mix metaphors somewhat) its nuclear deterrent.
  4. The feminisation of general practice. This has of course been a gradual process, but the recent news that female GPs now for the first outnumber male GPs in England feels like a real tipping point. If nothing else, it surely puts paid to any stereotype of general practice being an old boys’ club, and leading GPs such as Professor Clare Gerada and Dr Maureen Baker have rightly celebrated the move towards equality. Mutterings in the comments of that news story, though, suggest an unease in some parts of the profession about what a majority female workforce might mean in terms of the number of part-time GPs, and the fact that a clear majority of medical students are now female suggest this is a trend which is only going to continue. Whisper it, but the middle-aged male GP might be about to become an endangered species…

I’m sure you have your own list of ways in which the profession has evolved, for better or worse – do let us know in the comments.

And what of my personal highlights from the past seven years? Well, there are too many to mention really. I won’t miss having to wade through CCG financial reports, or having to get my head around the MPIG, but as a journalist, it’s been an absolute joy to work on an newsy, investigative publication in a sector teeming with stories, and to work with an audience who are informed, engaged and always extremely quotable.

The biggest story I’ve worked on? Well, the NHS reforms are an obvious contender, but I’d probably have to choose the 2009 swine flu pandemic, when for an alarming few days it seemed as though GPs might really be thrust onto the frontline of an unprecedented public health crisis. The most bizarre? Well, GPs have always suspected health ministers of living in a parallel universe, and on this occasion one actually did.

All the best to the Pulse team then, who I know will continue to do a fantastic job, and all the best to all the GPs out there too. As our ‘24 hours in general practice’ project earlier this week showed, you do a frankly awe-inspiring job.



Readers' comments (2)

  • Thanks for your time and good luck to your future, you have been great!

    - anonymous salaried!

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  • Vinci Ho

    Salute and farewell , my friend.
    We will prevail.
    God save general practice ....

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