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CAMHS won't see you now

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

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Readers' comments (72)

  • Flat6 - I would agree about a "separation of the powers" in politics but policy direction is something else entirely - you really do need somebody who knows what's happening "on the ground" to shape that. After all, the PCT days with little clinical input weren't that rosy, were they? The difference is that the CCGs now have much greater power with NHSE having offloaded most of their responsibilities to those same CCGs - if there's no GP input do you trust an NHS manager to be making decisions about your future?

    I would argue that if you're not part of the solution, you're part of the problem, and simply moaning without coming up with anything better isn't really being part of the solution, is it? Mass resignation or refusal to comply with the pointless nonsense we are "required" to do may be another route to change, but unfortunately this tends to result in casualties (us and our patients, cf the junior doctors' strikes). I would argue that it is less disruptive/harmful to change things from within than without. It may often seem like wading through treacle but it avoids unintended misfortune in angry revolt (Brexit, anyone?.....)

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  • The real problem is that those of us that go into leadership or management very quickly become institutionalised. We need radical front line docs to do these roles who are not afraid to stand up to the system. But they need the rest of their colleagues to support them, not paint a target on their ba

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  • Morlock?
    You are clearly a decent and altruistic Dr and your parents 'taught you well'.
    Mine also tried there best but I feel that in the sixth decade of my life I must appraise what they advised against what I have witnessed for myself.
    Improvement from within tends to be called 'Evolution' or Inovation butwhen it has the opposite effect to that intended it tends to be called Implosion.
    I fear it is the later that you are contributing to.
    History teaches that lubricating and sustaining a dubious status quo doses not usually have Desirable outcomes.
    The worthy Policemen,station masters and signal men' of occupied Europe were not aware of what would happen to the people they rounded up and loaded onto cattle trains in Metrapolitan railway sidings but in there own way they are just as guilty for that genocide as any of the Nazi hierarchy who planned it.
    Our situation is 'trivial'in coparison to that maelstrom but never the less people are losing there lives without need in the current Nhs crisis.They are generally the old and weak(further parallel's there perhaps?)maybe to some of the Mortlock's they are just statistics.Anyone fancy a nice Audit,perhaps you can put it in your next Appraisal folder?I'm sure that will help improve the situation at a rapid pace.

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  • Dr Mustapha Tahir

    Excellent piece! Mr Hunt your job of finding 5,000 GPs all done for you, by Dr Peverly. A recovering GP. Go get them. Send them all for the Induction and Referesher Exams and attachments (for those of thewm who manage to pass)and in 6 months you will have 5,000 Refreshed GPs!

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  • Vinci Ho

    Glad to see you back , Phil , in full sharpness. Agreed to most of the things you wrote in this article ,though everything.
    If I recalled correctly, H G Wells' original ideology about the eco-existence of Eloi and Morlock was dystopian.They both evolved from the same original species, namely human being. Question is who or what was the culprit which allowed this to happen?
    Our everyday work was heavily politicised by our common enemy . While we are fundamentally NOT interested in politics and just want to get on with we do best , politics is extremely interested in us. Data , statistics , guidances,protocols etc connected by 21st century IT technology is such an entertaining fairground for politicians,academics and technocrats . What we do everyday is of good value to earn political brownie points.
    Then it boils down to how we should respond together? Sitting to talk or drawing the sword?
    Cannot blame those who would want a peaceful resolution as a start but how far would one allow oneself to advance before becoming assimilated into the enemy's hierarchy? There is always a bottom line that cannot be crossed. Enough is enough but I yet to see any of our representatives pointing a finger to our common enemy in public and said in its face ,' Stop lying to people . Go back to hell where you belong !' I always believe the impact of all CCG GP commissioners in the country walking out is even bigger than our own mass resignation( which I also support ).
    Our system has been broken but whether it is genuinely beyond repair , I am not too sure yet. The outcomes of Eloi and Morlock seemed fatal but they should never be allowed to develop in the first place........

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  • The truth of it in a nutshell. Well written as usual Sir.

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  • Good to see you Peevs, but oh dear what's happened? You used to show great insight and humour in your blogs but this article is woefully uninformed and biased, to the point humour has evaporated and left bitter burnt bits of your previous wits.

    Before anyone asks, I do 1 day a week for my CCG, elected by my peers to represente them to ensure we are not shafted.

    No doubt there are terrible doctors in managerial position. But my experience is, the propotin is quite the opposit. Those in leading position often have far better knowledge of medicine (as they often deal with new guidance, secondary care etc) and have just as good consultation skills if not better (as they have to deal with board of people and other stakeholders). Certainly in my local area, I would not claim to be a better GP then them.

    And since when has general practice ever been free of politics? Is your aging brain altering the memory of internal politics played by the senior partner and his favourite PM to belittle younger partners to much more rosy memory? Do you not remember parity? As we run our practice, we've never been free of dealing with management - its just that it is more externalized and done on a bigger scale now.

    I suppose you belive standing still is the bestprotection against changing times? Do you not realize the once Great Britin, who ruled more parts of the world then Genghis Khan and took lands from China now ranks way below it's former colony in economical ranking precisely doing that? Repeating what we do everyday tomorrow will not stop the growing demand and aging population. If you belive clinicians stopped influencing management the managers will somehow disappear and leaves us alone, you might want to think back to PCT times. It wasn't great and that was when NHS had abundance of money.

    As many of my colleagues do, I get paid for 1 day a week but essentially do 2.5 days for the CCG, eating up most of my weekends and evenings. Unfortunately, uninformed blogs likes yours will only turn GPs against it's own organization which is trying to balance protecting primary care and protecting local health economy.

    I am sorry to see once wise and witty Peevs has come back blinkered and bitter. I truely do feel like I've lost an old friend.

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  • Brilliant artical, I was and will always remain an Eloi, after all who entered medical school to be a manager? Partnership did not allow me to practice the patient facing medicine I proudly learn, so I found want I needed in locum land.

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  • David Banner

    "Those who can't do, teach.
    Those who can't teach, teach gym"
    Agreed, too many gym teachers avoiding seeing patients whilst making the rest of our lives miserable.

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  • Healthy Cynic

    Great to have you back Peverley, and you're clearly back to full strength!

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