I'm too expensive to perform the tasks I enjoy
Dr Charlotte Alexander
So we're doing microsuction at the practice now, thank goodness. I'm glad to see the back of syringing, a technique of a Byzantine age that’s so crude it’s difficult to believe it’s gone on for so long. I was so pleased at the thought of it, I offered my services.
‘You're too expensive’, replied one of the partners. I can see her point - I suppose I am. They have recruited a new nurse who’s being trained to do it, and I’m sure she’ll be an expert before long. This is the life in general practice now.
I have four months of working as a full-time ENT SHO covering two hospitals on call, microsuctioning at 2am, dealing with post-FES bleeding, assisting in surgery, draining quinsies and hoiking fishbones out of piriform fossae, and cannot use my skills. I fit implants, and although I'm trained to do coils, have never fancied it as much. I like fitting implants - could I call it fun?
Specialist nurses perform the same jobs we do - often better - so how can we justify a bigger salary?
Well, perhaps that's going too far, but it is satisfying. Flow, I think it's called. I can’t do those either at my new practice, because a nurse fits them and guess what - ‘I'm too expensive’. We don’t have advanced nurse practitioners for minor illnesses yet, but I’m sure they’re coming.
Increasingly, I see that I’ll be left with shouldering the unpopular duty days and trawling through the heavy work of multi-morbid geriatric patients. I may give the impression that I don’t like my practice or working there, but I do. So how can I, as a salaried GP who enjoys practical tasks and seeing patients, increase my satisfaction? I say this as a general point, that there’s a slow erosion of diversity in a normal GP’s daily working life.
Specialist nurses perform the same jobs we do - often better - so what exactly makes us any different? How can we justify a bigger salary? The NHS is increasingly showing that it doesn’t think we do.
Of course, you can go into management in a new PCN, but that doesn’t interest me. I like patients. We're being devalued because what we offer is not so easily measurable. So, where can you now get the freedom to practise your diversity of skills as an ‘ordinary’ GP? It’s a shame that the only answer I can come up with is ‘privately’.
Dr Charlotte Alexander is a GP in Surrey