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At the heart of general practice since 1960

What has become of the job I loved?

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I have always assumed that, of the partners in my practice, I would be the first one into the lifeboat. The three of us are much of an age, although I am the youngest by a year or two. But after my cardiac event or three, details of which need not detain us here (other than to say they were not entirely unrelated to stress), I thought I would be the first to give it up and get out while there was still time.

I was wrong. Last week my partner Ian dropped his bombshell on us. ‘I’m out of here. I’ve had enough of all this shite,’ were his exact words, and when he reaches 55 next year, he is giving it all up.

He’s a brilliant doctor. Clinically astute, vastly experienced, loved by the patients, diligent, hard-working, my friend, and a man whom I have never seen angry or at a loss. In a quarter of a century, he has had two days off sick – although to be honest we thought playing the pneumonia card was a bit weak and he could probably have made it in if he’d really tried.

But he’s had enough. At 55. That might seem a tad young, but Ian, like me, did 10 years in hospital medicine on a one-in-three rota, and years doing all his own out-of-hours in general practice, so we have both already put in around two lifetimes of 40-hour weeks. I can see where he’s coming from.

What makes him want to leave? How have things changed at the practice? Let me count the ways.

We were never a particularly high-earning organisation. We never quite managed the six-figure income so beloved of the Daily Mail readership, but we were doing OK. Average, maybe. But for 12 years now, there has been no increase in our funding other than a few derisory sub-inflation uplifts. Our drawings were frozen for a decade, until we bit the bullet and took a 20% cut in our income.

That wasn’t enough. We developed a £100,000 overdraft, which has to be corrected by the three of us putting our own money back in. In effect, this means I work for nothing for six months, yet somehow I still owe £14,000 income tax on the money I’m not getting. My accountants assure me this is right, ludicrous though it seems to someone as financially innumerate as I am.

Our two NLDs (Nice Lady Doctors) are already out of here for pastures less depressing, one to Australia and the other to teach in a university. One of them was our trainer, so we now have no registrar either.

And, as always, the workload is increasing. The number of consultations at my practice has doubled over the past decade, with no way to deal with it other than to get your head down and see ‘em. All the bloody satisfaction has been leeched out of the job that once inspired me, that I once loved.

We won’t get another partner. One glance at our accounts tells me no one will be foolish enough to take on this depressing behemoth, where the salaried doctors earn far more than we do, without the depressing shite that goes with being a partner.

And I know we’re not unusual. Many of you are in this situation. The partnership model is unravelling with breathtaking speed. It’s finished. I’m finished. Genuinely.

Dr Phil Peverley is a GP in Sunderland.

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Readers' comments (55)

  • Thank you Dr Peverley.
    An excellent article, which virtually summarises the situation for many GPs of our generation.

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  • Una Coales

    Thanks Pev. I did try to warn everyone back in 2009 on my website,'The future is the end of the generalist and the rise of an underpaid, tick-boxing civil servant worker-bee salaried doctor working for APMS polyclinics run by overpaid managers. Medical decisions may be influenced by managers (who decide who may or may not be referred, place limits on investigations, over-schedule patients around the clock), etc.....the consequences: increased risk for both patients (mistakes and unnecessary deaths) and doctors (burnout and litigation).

    Why is this, the bleak future of general practice? Because the US is 20 years ahead of the UK and is a window into the future of medicine. Patients in the US are not registered with family physicians.....they see a paediatrician for children with URTIs and imms, an O+G doctor for antenatal care, pap smears and gynae and an endocrinologist for diabetes. The family physician is an employee of an APMS and works much like an internist working for a mini hospital/ polyclinic covering his own admissions, rounding on his patients twice daily, running morning and afternoon clinics and being on call. For all this, he is paid much less than partners over here because he is an employee of a HMO/ APMS.

    The College must not be seen unwittingly assisting government's big plan to overburden GPs to the point of early retirement/ resignation so that government may replace partnerships with cheap labour for the government's APMS providers and so too must GPs not devalue their colleagues but treat all colleagues with respect and fairness to end a 2- or 3-tier system.

    Let us save both our College and our GPs. This is a turning point in the history of medicine. If we do not take action now, then we lose our profession and the finest doctors in training will aim instead to become private cardiologists and diabetic specialists to treat the obese (24 million obese in the UK and rising), private bariatric surgeons and interventional radiologists to surgically treat the obese and their diseases or private plastic surgeons to treat the vain or emigrate to Australia. In other words, even the NHS will lose its finest doctors. At the moment, general practice has first selection of the finest doctors from medical school as it provides the best of both worlds: a medical career with sociable hours combined with quality time with one’s family. Let us save our profession. Let this be OUR finest hour. Let the GPC, LMC, BMA, IDF, NASGP and College unite against the dangers of politically-based medicine.

    It is a sad day if GPs do not fight for the survival of the generalist. The knowledge/ syllabus of the MRCGP/nMRCGP exam is actually quite good. As a result, the RCGP has turned out GPs who are the best generalists/ doctors in the world because not only can they attend to the physical ailment (as most hospital clinicians), but they can also uncover hidden concerns, bring peace of mind/ reassurances to patients and deliver holistic care (psychological, social, financial, pastoral emotional comfort, empathy), etc. to appease the soul. And that is a special and unique talent of all GPs which should be praised, extolled and valued and not made to face extinction by relentless government interference and further regulations on our profession.'

    The turning point has come and gone. The College and BMA have chosen to ask for more public money and promote a put patients first campaign instead of put family doctors self respect and wellbeing first. And one ex Chair has even supported a salaried GP service.

    We are now headed down the road of salaried employees of APMS/HMOs/ICOs or whatever euphemism best describes loss of independent autonomous general practice.

    When I was a surgical resident in NYC many decades ago, working at a semiprivate teaching hospital, I noticed we had some visiting HMO surgeons who had patients on our theatre lists. I also noted there was an underlying bias against HMO surgeons. I asked the fellows and surgical residents why no one wanted to scrub to assist the HMO surgeon? I was told it was because they were not as good as teaching hospital attendings. I think one of the scariest moments was when I volunteered and scrubbed to assist a HMO surgeon. I won't say more.

    In the States there are 2 types of doctors, those who work as salaried employees of HMOs and those who choose independent semiprivate practice. The ones who cannot find enough patients in semiprivate practice, which operates chiefly through word of mouth, may end up working for HMOs.

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  • Azeem Majeed

    A very good article which will echo with GPs in many other practices. In my own practice in Clapham, London we have also seen large increases in workload in recent years combined with reductions (both in absolute and real terms) in our practice budget.

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  • spot on. The tipping point is long passed. This Government has accelerated the problem massively but the political drive and direction has already been set in place for 20 yrs and NHS Titanic has already hit its iceburg. Unfortunately the politicians have seen fit to set fire to all the lifeboats......maybe they think it will keep us warm.

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  • With an election looming why doesn't the BMA/breakaway union play the undated resignation card? It's a winner!

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  • Dr Peverley I hope you're able to save yourself

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  • Where are all the anti-Pev trolls now? Where are the "other healthcare workers" who normally feel the need to shout and gurn when a GP columnist dares to suggest that not all of our patients are as truly needy as they wish to appear, or that GP stress is rising and there is no obvious lilght at the end of the tunnel?

    Your words are a stark reflection of the feeling of much of the profession Phil. Thanks for putting it so well. I wish you and your practice all the best.

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  • I don't really know why I keep reading Pulse having taken VER 18 months ago at just over 58. I guess it's to check that it really isn't/ wasn't "just me" who was afflicted by the depressing circumstances that Dr Peverley so vividly recounts. Now enjoying retirement with a pension which is greater than my drawings were after tax. To all those that remain I can only encourage you to get out if you can...while you can...

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  • Your health comes first,family second and the patients third.Don't allow yourself to be consumed by the messiah complex.GP is a thankless task.Get out whilst you still can.Life is too short for this nonsense.

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  • Great article. Same at our practice . I'm 51 a really good doctor and trainer 20 years - last day tomorrow . Only 2 partners left out of 4 of us

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