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Gold, incentives and meh

Here's a catchphrase we can all get behind

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Those of you who were teenagers in the 1980s will be familiar with the ‘Just Say No’ drugs campaign, hijacked from Nancy Reagan and the Republicans in the USA.

Maybe we should all be encouraging the RCGP and our leaders to rebrand this catchphrase in order to manage the relentless and unsustainable demands of our patients. There has been much lip service given to self-care but most of it is skirting around the edges, focussing on patient education rather than negative reinforcement of attendances.

Let us start with the most basic reinforcer of attendance; the prescription. Despite the massive publicity campaign to reduce our prescribing of antibiotics, I still see significant numbers of prescriptions justified on the basis of sputem colour or sticky eyes. But at least there is still an element of rationing of these as they are prescription-only medications. The enormous prescribing of cheap, over-the-counter medications, often with limited evidence base, is surely not what the NHS was set up for? Many GPs feel uncomfortable with dishing out bottles of Calpol, pholcodeine and enough emollients to survive the English Channel, but are too fearful of the NHS complaints system to behave any differently. It’s a lot easier to point to a policy than to stand up as a lone GP and explain to a patient why you are the only doctor who is not prescribing the Forceval they have received for the last 20 years.

Another issue is the medicalization of any manner of human emotion and processes - from exam stress to relationship breakdown and even TV appearances, all of which are legitimised by the obligatory GNFYD (Get a note from your doctor) We are more concerned about jeopardising the doctor-patient relationship than preserving our role and this results in us conceding to all these requests.

Finally, we have silently accepted the insidious shift in our role from family doctor to public health physician, which will no doubt worsen with the move of public health to local authorities. Obesity, smoking, vitamin D and most recently aspirin in pregnancy are just a few of the public health issues that need to be tackled on a population level rather than GPs continually attempting to add the rope and saddle to Buckaroo.

Our leaders should be furnishing us with the tools to improve our collectively low self-esteem and regain our self-respect and professionalism. Rather than trying to persuade us to federate, open 12/7 or tell us we are better off salaried, why are we not being encouraged to be more assertive so we can reclaim our agenda – both with patients and the government.

We need to remember our youth and…Just Say No.

 Dr Shaba Nabi is a GP trainer in Bristol

Readers' comments (17)

  • agree with some points, however, it sounds as if most GP's no longer want to look after people. Unfortunately you are pick and chose and only look after those cases that you feel are interesting.

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  • Why are GP the scapegoat for everything now from girlfriend tantrum boyfriend moods football team loses economic crisis that man behind the tree mugging that woman selling drugs the car prices foods prices Iraq weapons of mass destruction Abraham Lincoln Murder jaja binks from Star Wars the price of a loaf of bread and also responsible for your health his health that animals health that plants health the pressure in the car tyres of the planet Uranus the cause of the Mary Celeste and everything else ... After all why so we even have a family why even a life of our own why even a thought why breath just take a big breath and work and work and remember its a vocation always has always will be so anyone even dream about dreaming about anything they should be reported and put in their place
    Why do GP have no backbone why ?

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  • The PM said yesterday that take home pay has gone up. Our pay has fallen 25% in real terms and our consultations are up by over 60% in the last ten years. Our take home pay per consultation here in N Ireland is £ 2.50 on average. It used to be £6.00. This fall inspite of QOF, LES, DES etc. Work out your own take home pay per consultation. It cannot be more than £ 4.00 at best. It is time for the GPC to say no. It is time to ballot the profession on whether we wish to work for £ 2.50 / 4 per multimorbid consultation or follow the dentists and leave. Is the GPC afraid to ask ?

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  • Edoardo Cervoni

    I subscribe Nabi's thoughts and views.
    However, I can see a struggle there, which is not just finding a GP to have the "gut to say no".
    May I also add that, contrarily to what an anonymus pointed out, having travelled and worked quite a bit in my professional life, I Thank you Nabi for your heartfelt letter.
    I subscribe your thoughts and views.
    I would like to add that it is not just finding a GP to have the "gut to say no", or as an anonymous before me pointed out, about having more “caring” GPs.
    I have travelled and worked a lot in my professional life, looking for the top healthcare system, victim of the misconception that the grass is always greener on the other side.
    A fault of youth, I say today. I did not find such a place.
    In the other hand, I learnt how similar problems can be tackled in different ways and I was reassured that the overwhelming majority of colleagues went into Medicine because they do care about helping people and do love their profession.
    I have no reason to think that “anonymous” wrote about lack of caring attitude to upset all the readers who are also healthcare professionals. I believe that anonymous witnessed what I call frustration. It is with concern that I have seen this feeling growing steeply across Countries.
    My view is that the situation we are facing is very complex and to be successfully addressed it does require a cultural change from all the stakeholders (sigh!).
    Firstly, we should look at the role we played as healthcare professionals in “generating costumes”.
    I have emphasized in different publications, how not appropriate antibiotic prescribing has at the best generated wrong beliefs among many patients. In turn, this has triggered a "business growth", which is a quite unhealthy growth.
    We are stunned by the plethora of patients attending GP surgeries, OOH centres and A&E Departments with sore throat. Why patients are coming to the surgery for an antibiotic for sore throat?
    Well, it happens that we have been prescribing antibiotics for sore throat for decades and we did advocate them. In other words, we did educate patients that this was the right approach and stepping back needs a very good explanation. In fact, this is a very hard thing to do (no just in Medicine, of course). Looking at the same aspect of care upon a different perspective, we could say that our profession has “facilitated” a “medicalization” of our society. To put it in another way, we are now dealing with the consequences of promotion of a service by sub-optimal clinical problem management.
    Growth can be good or it can be bad. Too much growth can overwhelm people, processes and controls. It happens that the Public Finances and healthcare professional’s workforce are limited.
    Growth can:
    1. Stress quality controls
    2. Stress financial controls
    3. Dilute one’s customer value proposition
    4. Dilute one’s culture
    5. Put one in a different competitive space
    It seems to me that NHS is experiencing all the five problems.
    I am sure that NHS should be much less about meeting targets, but –with realism- about meeting healthcare needs using a finite amount of resources.

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  • Unfortunately the idea of more work for less pay is an agenda that is being pushed into all aspects of healthcare. It is an idea that sounds good verbally; but the implementation and the practicalities have not been thought through. Many health care professionals and not only GPs indeed feel that they are not relevant or not regarded to be of any worth when important decisions with wide implications are made. Leaders need to start listening - or cuts will go to deep some day soon and it would cost a lot more to fix the damage. Healthcare professionals need to be well mentally and physically to give their best...Dr Shaba welldone for speaking up - are there any other brave GPs and Healthcare leaders out there? Let's all "Just Say No" togetther.

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  • There is a movement to change GP attitudes and develop assertiveness and resilience in the profession: at times we have to protect patients from themselves and say No more often, even at the risk of complaints. A small but growing number of GPs are developing strategies to deal with this- and train GPs how to deal with demands assertively but sensitivelty - see the ResilientGP movement - http://www.resilientgp.org/

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  • While we are talking about "just saying NO", isn't it about time that GPs just said NO to the government the next time it dumps unfunded work on us. We have been far too meek and submissive for far too long. We have an iniquitous contract that allows the government m9inister to dump whatever he wants on us. It's time we started to say NO - we are not going to take on this extra work unless you pay us appropriately.

    Airline pilots have strictly limited working hours on the basis that if they are tired and stressed, they might make a mistake and cost lives. Junior hospital doctors got the same concession by flexing their muscles. It's time GPs woke up to the fact that they are being taken for a ride by an unscrupulous government. It's time to tell the government that for the sake of our own health and that of our patients we cannot take on any more work unless it is properly funded so that we can take on extra staff/partners to do the work.

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