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At the heart of general practice since 1960

Mr Hunt! I know where your 5,000 extra GPs are

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The Darwinian theory of evolution applies to general practice as much as it does to anything else. When an environment changes and a new niche appears, something will evolve to fill that niche. This has happened to us in primary care.

There used to be but one type of GP; he or she would work in a practice and see patients, because that’s all there was. But in the past couple of decades a new niche has appeared, an area that contains opportunities for bureaucracy, quangos, regulation and governance. And crucially, the chance to not see patients.

As a result, GPs have evolved into two tribes; let us call them, for the sake of argument, the Eloi and the Morlocks.

The Eloi tribe, of which I was a proud member, are those of us who do the clinical stuff. We like to see patients and make clinical decisions, we are available and accountable. We avoid politics and management. We are, in fact, what the public thinks of when they think of a GP.

The Morlocks are those of us who have missed our calling. They have found out, perhaps after some time of being exposed to it, that they don’t really like clinical practice, or patients, or working out complex problems on behalf of others. But hey! Nowadays, they don’t have to!

The Morlocks seek out committees. They go into management, medical politics and clinical governance, they spend their time devising ever more complicated protocols, they develop increasingly byzantine and infuriating regimes for appraisal and revalidation, they join CQC inspection teams and CCGs, they become clinical directors. They work for NHS England. They become MPs. They don’t see many patients. And they feed on the Eloi.

We could JUST practise medicine.

If they were left to themselves, as they are still just about in a minority, it would not matter so much. They weren’t usually good clinicians anyway. But no Morlock can justify their own clinical irrelevance without imposing their influence on the Eloi, which is having a serious and deleterious effect on the way we Eloi can do our jobs. Weeks and weeks every year are taken from us as we are forced to leap through Morlock hoops, collect nonsensical data for appraisals that are no benefit to anyone other than the Morlocks. We worry that a Morlock CQC inspection team will find something vanishingly unimportant in our practices that will absorb staff and clinician time (and they always do; every Morlock suffers from Witchfinder General Syndrome) and take us away from our true calling. And they are getting very good at doing just that.

One of the major problems in general practice today is access for patients. Waiting times to see a GP are becoming untenable and unsafe; practices are underfunded and understaffed. But I can solve this problem, ladies and gentlemen, in one fell swoop, at least temporarily.

I propose a complete moratorium, for the next full year, on every appraisal, revalidation, CQC inspection, meeting, new initiative, audit, everything that takes us away from the clinical coalface. We never used to have these distractions, so a further 12 months away from this nonsense will make no odds. We could JUST practise medicine.

In addition, all those Morlocks, deprived of their toys, could join us on the front line and do some bloody proper work for a change. They could go back to their own practices, or work as salaried GPs or locums, for exactly the same remuneration that they get for doing whatever it is they pretend to do now. Except, now they’d be doing something useful, in fact what the public is crying out for.

Waiting lists would drop, consultations could be longer, patient satisfaction would go up, health outcomes would improve, and those patients who say (justifiably, in my opinion) that they attend A&E because they can’t get a GP appointment would not be able to say that any more.

I can see no flaws in this. After a year, we could go back to the depressing system we’ve got now, where one part of the profession is doing its damnedest to demoralise the rest, but I suspect that enthusiasm for this would be low (unless you’re a Morlock). If we have to have appraisals and inspections, we could do them alternate years and halve the pain.

You see, Mr Hunt, I KNOW where the extra 5,000 GPs you have promised by 2020 actually are. They’re hiding in plain sight. They’re there, but not doing anything that a normal GP would construe as useful work. And they’re sitting on a committee near you.

Dr Phil Peverley is a recovering GP in Sunderland

This blog is part of our ‘Great GP Debate’ season. If you would like to write a blog on how you see the future of general practice, then please email the Editor at editor@pulsetoday.co.uk.

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Readers' comments (72)

  • Welcome back hope you are well.

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  • Well Said!

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  • I said this before and am saying it again,
    Peverley for prime minister!

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  • Brilliant! And we all know who the Morlocks are!!

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  • I just hope someone is listening.

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  • Cobblers

    Yes echo the "Welcome back". Hope to see you on DN-UK perhaps at some point?

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  • 100% agree Phil - Morlocks should look in the mirror and ask themselves how they have helped patients or their colleagues by being involved in non-clinical work e.g. Stps CCG, CQC etc. There are exceptions but the majority would have made no impact and some even worsened the situation for us on the front line.

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  • Administratum: A Chemical Analysis

    Administratum

    Physicists at Harwell have discovered the heaviest element
    known to science, named Administratum. The new element has no
    protons or electrons, and has an atomic number of zero.
    However, it does have one neutron, eight assistant neutrons,
    ten executive neutrons, 35 vice neutrons and 258 assistant
    vice neutrons.

    Administratum has an atomic mass of 311=, since the neutron
    is only detectable half of the time. Its 312 particles are
    held together by a force which involves the continuous
    exchange of meson-like particles, called morons.

    Since it has no electrons, Administratum is completely inert.
    Nevertheless, its presence can be detected because it impedes
    every reaction with which it comes into contact. One
    experiment, which should have lasted only a few days, is
    still running after 2= years due to the addition of just one
    milligramme of Administratum.

    It is weakly active, and has a normal half-life of
    approximately six months. After this time, it does not
    actually decay, but undergoes a metamorphosis in which
    assistant neutrons, executive neutrons, vice neutrons and
    assistant vice neutrons exchange places. This almost
    invariably leads to an increase in atomic weight, hence it is
    self-sustaining.

    Although it occurs widely, Administratum tends to concentrate
    around large corporations, research laboratories and
    government departments. It can especially be found in
    recently re-organised sites, and there is reason to believe
    that it is heavily involved in the processes of deforestation
    and global warming.

    It should be remembered that Administratum is known to be
    toxic at all concentrations, and can easily destroy any
    productive reactions where it is allowed to accumulate.
    Numerous attempts have been made to determine how
    Administratum can be controlled to prevent irreversible
    damage, but results to date are not promising.

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  • Thanks Phil,entertaining and insightful as usual.As a GP of 26 years,who went early at 55yrs,I would like to offer the following 2 observations to augment your article.

    1.The 'Morlocks'were there all along,every practice had one.
    They were the Dr that no patient wanted to see,diagnosed everyone with 'UTI' or 'Chest infection',based mainly on there mood or the season.They reported many more 'Allergy's'than anyone else because that was the term they used for any other condition that required a relevant history and examination.
    The difference between then and now is that they were fairly easily marginalised by those who 'got it',so they drifted off with the consent of the majority to do boring jobs that the 'Eloi' didn't want eg Post Grad advisor,Dean of Gp,appraisal lead,clinical director.
    I don't think we can blame ourselves for lacking insight,because no one thought that the conditions could arise in the future where these 'inaffectual Dr's could gain the power over the 'competent majority'.This is what has happened and it shows parallel's with Pol Pot's Cambodia,where they thought they could improve the country by making all the educated and able people labour in the field's.
    This process was aided and abetted by the RCGP,who around the same time became obsessed with 'Audit'.This was because they found it hard to identify what made GP a specialty rather than the Specialism that it probably is.This 'agenda' suited all Government's because they preferred to deal with this new class of Dr who the Media referred to as 'a Leading Gp/Dr'.

    2.When you refer to the 'Missing 5,000 Dr's, you were out by a factor of 3.

    The 'Morlock's'have never been Clinically effective front line Dr's anyway----Minus 5,000.
    The 'Morlock's'had to remain nominally perhaps one day per week in practice and went on unchallenged('leading Gp's after all) diagnosing every Third patient as 'UTI/chest infection/Allergy.This meant that those patients who did not have wholly self limiting conditions such as Urological Cancer or Lung cancer/Heart failure needed to make repeat visits to see the remaining 'Eloi' in order to get a proper diagnosis.
    These repeat visits removed from the system the nominal equivalent of the 'Dr hours' of another --5,000 Dr's.
    Finally the strain of this plus the sheer stupidity of the Environment that the 'Morlock's'had created(eg Gp' on the GMC GP register being only able to work in one part of the U.K. but Not another)lead at least 5,000 of the remains 'Eloi' to remove themselves from the scene, so giving a Gross deficit of more like 15,000!

    I suspect that readers will conclude that I see myself as being an 'Eloi'and I do.Tell you what being a 'Former Eloi' is even better.No nonsensical phone calls from managers just out of school,no 'cow towing' to the GMC who are in reality just another branch of government that we pay for.How many 55yr plus 'Eloi'will remain?

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  • Brilliant. Good to see you back.

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