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The waiting game

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

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Readers' comments (16)

  • Or in another country.

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  • please-delete-this-fucking-profile-i-cant-delete-it-in-my-account-settings

    I don't think there's really space for a viable private general practice of any significant size in the UK. Not as long as the NHS exists. OK there's the odd clinic in large cities serving busy working types and there's Babylon (but then that's isn't actually general practice is it). We're busy getting rid of Drs in primary care in the U.K. I have to agree with the first poster, if you want to be a GP in any real sense, looking forward, you're going to have to emigrate.

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  • I concur....emigrate..... I have no idea what the NHS plan is.... but have a look at this article from Down Under......
    I would add dermatologists and gastroenterologists onto this list..... their days are numbered too... photodermoscopy AI - if a GP can do a biopsy.... then with AI what does a dermatologist add that AI can't???????

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  • "How can we justify a bigger salary?" - maybeeeeee cos we hold more of the risk and responsibility???

    You might not even need to emigrate. Simply move, there won't be specialist nurses to do everything at every practice in the UK. Rural practice?

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  • When I arrived in General Practice in rural Devon.... we ran a small hospital, a 24 h minor injury unit, our own on call .... at its best with 16 rural doctors sharing. We did our own intra partum midwifery, we were trained to fit coils etc, do smears, minor surgery.
    When we appointed th partner after me we had 100 or so applicants.
    Now the hospital is closed, we dont cover a minor injury 24 h unit. There is no midwifery. The partners almost never visit. There are no longer personal lists. The oncall is covered from 30 miles away ....

    Much less responsibility, Having got rid of all the interesting stuff ...guess what ? Noone wants the job anymore.

    When I was asked what I thought ...I said if I could do what I did ...I would do it all again. If I was asked to spend the next 28 years doing what now masquerades as General Practice I wouldn’t consider it.

    The partnership model in my view was fantastic in riral areas and towns where men and women wanted a high degree of committement and the rewards it gave... which were rich indeed.

    New Zealand may be your only hope!

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  • If you want more a more practical job then remote and rural Scotland is ideal - we don't have enough practice nurses to do all this stuff so the GPs do it themselves, plus there are community hospitals with non bypass A+E departments all run by GPs!

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  • What is this fixation with earwax? Seems to dominate discussions at my practice and CCG too. Ask hospital if they want an ENT clinical assistant and you can use your skills there. There are plenty of private providers where the bunged up can be relieved of their wax for a small fee, and get a new pair of specs at the same time.

    Learn to do joint injections: quick, useful, skilful, easy to master. In my experience you will find plenty partners happy to delegate this your way, you will reduced referrals to 2C and make a bit of money for the practice too.

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  • Work in a small practice as a partner and you can do all the practical stuff yourself and I bet that you will be more efficient than a nurse.
    Stop doing some of the useless overprescribing and overreferring and you will save plenty of time to spend on the stuff you like.

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  • Having spent 6 months in ENT, my subsequent GP training practice and a subsequent employing practice were severely concerned by my proposal that I could use suction equipment instead of the GPs syringing ears. They mentioned the risk of me sucking bones out of the middle ear!
    Yet nobody has expressed any concern about nurses doing this - except me!

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  • I assume the microsuction is an enhanced service activity - otherwise - why is anyone in your practice doing it?

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