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At the heart of general practice since 1960

Why I’m retiring

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Thirty years ago I was a young GP. If a medical student had asked me about career choices I would have been very enthusiastic about general practice. We had high status in the community, the workload was significant but manageable, the salary was that of a professional person. There was security in the job. External management was light-touch but competent.

Thirty years ago I was setting up a diabetic clinic in my practice. I worked on it in collaboration with a local diabetes consultant who was keen on joint working, and trusted us to develop high standards of care. We looked after our own on call, being responsible for people every hour, every day, all year round.

It is hard to convey what it was like then to the doctors of today. I do not have the writing skills of an A J Cronin or a Francis Brett Young to describe what it was like, but I was happy and fulfilled. I was a young man then. I was able to look at the more experienced doctors and imagine what life would be when I was their age. There were many working in their seventies, and doing a good job.

I was able to go home for lunch and see my young family growing up. I had time to pick my young daughters up from their primary school.

The work was busy and challenging; I would spend some nights in and out of the local GP maternity unit working with experienced midwives to assist with (and sometimes deliver) babies.

The doctors I worked with were a community; we had annual BMA dinners, and met at postgraduate meetings each week. We respected our neighbouring GP practices, and didn’t see them as competition. Illness and early retirement was rare.

That was then.

I look at where we are now. Much of what we experienced then is now history. GP maternity units have gone, consigned to wither away thanks to an ill-judged report written by a Government stooge with an agenda. That stooge is on the Tory benches in the House of Lords now.

Going home at lunchtime is now a joke. I cannot remember the last time I had enough time to do that, and certainly I would not be able to pick up my grandchildren from primary school. Socialising with other GPs is a real rarity, and there is no local BMA dinner any more. Education tends to happen late at night, alone, with a computer and a website.

Over the last nine years, our income has been frozen. The mandarins and politicians at the Department of Health have imposed this as a result of the cack-handed 2003 GP contract which abolished the ‘Red Book’ and gave ministers and others unprecedented control of GPs’ lives and working patterns. They have continually abused that power to achieve their short-term, politically-driven goals.

When I was deciding my future 30 years ago, I looked at the senior people in my profession, and looked at their lifestyle and satisfaction, and I liked what I saw in general practice – good work-life balance, professional autonomy, respect and happiness. But consultant colleagues were much more miserable: that helped me decide.

Now what I see is more troubling. GP colleagues are retiring earlier, and suffering more ill-health. There is a feeling that full-time general practice is virtually impossible to sustain for any length of time. In my patch it is becoming rare for a GP to be over 60, full-time and happy.

That’s why I’m retiring.

The Jobbing Doctor is a GP in a deprived urban area of England

Readers' comments (7)

  • I am retiring early at the end of the tax year and my local PCT tell me they have never known so many GP's retiring at the same time!

    I am looking forwards to being an ex doctor who was fortunate enough to work most of my career during the hay day for general practice.

    Advice to students thinking about a medical career. Do something else

    Advice to new doctors. Don't go into General Practice, you will simply be controlled by managers checking that you have ticked all the right boxes.

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  • completely agree. Retired 2 years ago having experienced the 'golden years' of GP. Now for all the reasons listed above, I rarely recommend a career in GP. All innovation at a practice level has disappeared and there is no such thing as a primary health care team. The DNs do not communicate with the Docs and do not even put up subcut fluids so managing ill patients at home is difficult. HVs remain even more of a mystery. What a mess!

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  • Mark Struthers

    Ben Goldacre understands. His new book on pharma corruption opened with the words, "Medicine is broken". What Goldacre didn't mention was the treatment meted out by the medical profession to Professor John Walker-Smith on behalf of the vaccine industry. GPs accepted what happened without a murmur. The game is over: Goldacre is right. Dr Jobbing is right to go.

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  • Well I am in a similar situation to Dr Harris. I have been in a partnership for nearly thirty years. I still have children of school age and had always intended to work until I was 63-65. This was not because I needed to but because I for many years enjoyed the job so much. On top of this I felt a strong belief in the NHS that I felt it was my duty to work until I was 65 to contribute to Bevan's and Beveridge's great edifice.
    As a practice we have always been very busy. We were not part of a OOH group for the first fifteen years of my practice so did all our own on call covering 900 square miles. We ran two hospitals between the five partners. One a fifty bedded Geriatric Hospital and another sixteen bedded acute GP hospital. We also had and ran a 24 hour casualty and our own midwifery unit. We were on call for our own patients deliveries all year round whether or not we were on call. In other words we ran pretty well everything and I LOVED it. Knackering but fulfilling would cover it!
    We of course in a great position to start new disease prevention and monitoring clinics and employ more specialist nurses etc etc. For fifteen years we never stopped thinking of ways to try and improve the care of our patients.
    Then starting with Ken Clarke's reforms slowly but surely our independance has been whittled away. I estimate that new partners coming in from around 2000 have never thought of an original idea because we have spent the entire last decade putting in place other people's ideas of primary health care. Some good, some bad , some unspeakable, none envisaged by us.
    There has been a never ending move towards ""prevention" to the extent that we have have less and less time to deal with patients that are actually ill or dying. These and other ill patients are now looked after by others. Whilst of course some of this is good and inevitable; it to my mind has happened to too great an extent. Our availability to have the time to nurture and care for patients as they go through their crises and illnesses has become less.
    To cover the guidelines of people deemed to be at risk a quite staggering percentage of the apparently well are now on an extraordinary concoction of polypharmacy. Often these guidelines which seem to be applied to everyone are extrapolated from specific groups and the outcomes may well not be the same for all those who are being treated. Increasingly in conversation I find GPs saying that they wouldn't take all this medication themselves!!

    I am saddened that the GPs, who at their best were among the most innovative of doctors, have become through pressure the workhorse of a centralised medical system that is in danger of treating everyone as if they were the same. Saddened that our wider role of seeing the person with the disease as the centre of our concerns is being relegated behind targets. Doing the job we feel we should do is being relegated behind being seen to do the job others percieve we should do.
    An example of this thinking is considering risk factors such as Cholesterol levels and high blood pressure as diseases. We then treat these diseases to a target rather than discussing when mediction is potentially indicated what the benefits and risks of such treatment are. For instance how many people you would need to treat for 10 years to prevent a stroke or heart attack and then encouraging our patients to make an informed decision. This rather than a target based approach would be an intelligent way to proceed.
    So I am a little further down the road than Dr Harris. I went part time earlier this year and now have decided to retire next year just before my sixtieth birthday.
    It must seem odd to the non doctors that when running two hospitals, a casualty and doing large numbers of out of hours I LOVED this job. Now working 8-6.30 I find it unrewarding for me and I dont believe that patients feel more cared for.
    My son is fourteen. If he were to try to become a physician I would be quietly delighted. He has poor sod a father, two uncles, two grandfather, a great grandfather and even a great great grandfather who are physicians! But what would I say to him if he had expressed a wish to become a general practitioner in England. Ten years ago I would have encouraged him now I would not. It no longer strikes me as a job for an independent thinking man or woman. Of course he might choose to disagree!

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  • In Australia you can still work as a GP obstetrician, GP anesthetist or GP surgeon if you have the experience. Non-city GPs often Admit and look after their own patients in the local hospital. We excise skin cancers, set fractures in plaster and do all sorts of other hands-on procedures. It's the way general practice should be, lots of job satisfaction and not just office-based 'script or refer'. The pay's better too. Personally I don't think I could go back to NHS general practice.

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  • I did a lot of work especially in New Zealand in the 1970-80s ... and thoroughly enjoyed it.
    Here as I say when i started we ran two small hospitals, took Xrays, developed them, ran a 24h casualty, and were involved in intra partum obstetrics. Now we do almost none of this. Actually before I finished obstetrics I delivered a young woman who seventeen years earlier I had delivered. I may be one of the last GPs to ever do that!! So I like Timothy loved the active general practice that now feels like a distant echo.

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  • It's quite sad to read all of the above.
    I am 2 years post VTS and have just taken on a partnership. I know that I do not have the ability to compare things to 20 years ago being only 10 at the time but I still believe that this is a career that provides significant job satisfaction, security and a good lifestyle for a 30 year old.
    There is a relationship that we have with our patients that no other doctor does. We are still a highly respected profession within the eyes of the community.
    I agree that the government feel that they can get away with anything at the moment but I suspect that this is true for all public sector jobs unfortunately.
    I would still encourage this as a career.

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