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A faulty production line

Para-doctors will not save the day

Dr Katie Musgrave

Faced with a shortage of medical staff, the Government is busy scrabbling around to find a solution. Its deep-seated concerns are not ill-founded. It’s going to be messy - any fool can see that.

But is diverting paramedics and pharmacists into fast-track medical degrees the solution? I think not.

Getting people to enter training is not the underlying issue we’re facing in the UK - it’s getting people to stay working as doctors, once qualified.

Increasing numbers of junior doctors are choosing to move overseas and work abroad. Fewer now continue into core training schemes from their foundation years. Running the bath faster isn’t going to stop the water from draining through the plug.

So, faced with a significant shortage of doctors, there are several options. One is to overhaul the health service and redesign what’s on offer, and how it can be accessed by the population.

I have no doubt the Government is looking into this. The second, which seems the primary strategy at present, is to train more and more to be doctors, especially GPs. The hope being that of those that are trained, at least some will stick at the job, conditions might improve a little, and the pressure on the system ease.

Many mental health problems seen by GPs could be managed by a community mental health worker

A third option is also open to NHS leaders. If you have a scarce resource, set to imminently run out, a wise person would look at the demands placed on that resource - to see if they could be reduced.

Take the hosepipe bans which come into force when there are significant water shortages. It’s time to take a similar approach with primary care. At present, there are multiple services provided by GPs, which could easily be outsourced to others.

NHS England should embark on a strategic review of the work being done by GPs, and make a concerted effort to meaningfully reduce the demands placed at their door. Rather than viewing the service as a free-for-all, they should view GPs as a precious reservoir in a time of drought.

One suggestion: contraception services need not be supplied by a GP. If coils, pills, implants, smears and reviews of menorrhagia were all done at nurse-led contraceptive clinics rather than GP surgeries, there would be little detriment to our patients. A properly resourced contraceptive clinic with experienced family planning nurses could provide an equal service to that presently being provided by many GPs. It would free up a lot of time.

I would also argue, perhaps more controversially, that many of the mental health problems seen by GPs could be managed by a community mental health worker.

They could work alongside counsellors, with links to community mental health services. This would need significant investment, to provide a good-quality service; but it could be done, if the Government was willing to make the necessary investment. At medical school, I had minimal teaching on psychiatry, and there’s no reason that a GP needs to be responsible for low-level mental health issues.

Rather than train all and sundry to become doctors in the UK, we would be better to recognise the true value of a medical professional, and seek to retain their rigorous scientific and clinical training. And in valuing these professionals, we should ensure that they’re not left responsible for every bit of work needed to be done by the health service.

But perhaps the real issue we face isn’t the shortage of doctors. Rather, it may well be the dogged unwillingness of the Government to accept that general practice isn’t an all-you-can-eat buffet.

Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West

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Readers' comments (10)

  • How about Health and Social Care (including the Act) being disengaged (and Act abandoned)? A nice idea (maybe), but it doesn’t work!

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  • Worst case scenario is all the easy stuff being taken off us so all we have is complex functional and chronic illness patients with polypharmacy that have been through every speciality and now dumped on us

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  • GENERAL PRACTICE COULD EASILY BE SOLVED THROUGH THESE OR OTHER MEASURES.
    THE PROBLEM IS THAT THE GOVERNMENT SIMPLY WILL NOT ACCEPT THAT QUALITY COSTS.
    THE PUBLIC SHOULD BE PUNISHING THE GOVERNMENT OVER THIS BUT SO FAR HAVE BEEN VERY GENEROUS HENCE THE PRESSURE FOR CHANGE IS ONLY LIMITED

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  • Always need a doctor to accept final clinical responsibility-hence dozens of emails daily from noctors!

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  • The public don't give a monkeys until they are personally, gravely affected.
    Sure, they'll grumble...and do NOTHING.
    So long as Netflix is working, they can pay the rent and go on hols to Spain once a year they really couldn't give a S**t.
    The NHS: nice while it lasted.

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  • so my questions are
    1, who is going to train and support these people when they move into primary care? Like many other experienced GPs and educationalists, I left mainstream primary care last year, exhausted and fed up... with no intention of returning! They can’t train and develop themselves!
    2, when they finally get into primary care..... why won’t they get burnout , fed up and resentful like the rest of us and then leave too?
    The issue here is not ‘recruiting’ as I see it but ‘retaining’...... but they don’t seem to grasp this!

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  • Or... they could just fund the service properly, rather than blowing all their money in inefficient ways in hospitals.

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  • |DT | GP Partner/Principal|07 Feb 2020 7:48am

    So what would you cut in the hospitals? Reduce management wages? Cut elective hip replacements? Elective gallbladder removal? Religious circumcisions? Treating benign skin lesions? All elective treatments altogether? If you were the state, and spending taxpayers money, and had the choice to have 'power' over all these elements, would you cut them? I'm sure you see where I'm going with this

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  • "Elective treatment" does not mean inessential. We can all think of hip replacements getting people back on their feet and paying for themselves in reduced need for other services.

    Funding depends on political will, and somehow I feel that the Government hates GPs. The reason the partnership model is collapsing is because the Government stopped supporting it. Once you lose the confidence of GPs, then no young doctors will join and older doctors find it difficult to recruit. It is like a run on the Bank. Confidence is needed for the system to operate. It is incredibly expensive to rescue once confidence is lost. This wound has been self inflicted. The Government is very slow to learn, if at all.

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  • Next step: Plumbers = Urologist
    Carpenters = Orthopods
    Watch makers = Opthalmologist.
    Painters = Dermatologist
    Barbers = Surgeons.
    Drug addicts = Anaesthetics.........


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