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At the heart of general practice since 1960

The five stages of grief for general practice

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I have been grieving.

It wasn’t expected, it took me by surprise. No one had died, I had had no terminal diagnosis, but the signs were there. I kept dwelling on the ‘good old days’, and the great time we had together. My mood was flat, sleep poor. I found myself staring at the empty wrapper (OK wrappers) of Green and Blacks chocolate.  Steadily the understanding hit, I, like many of us, are in a sort of mourning for the general practice of yesteryear. 

According to the (slightly debatable) Kübler-Ross model there are 5 stages of grief: denial, anger, bargaining, depression, acceptance. 

Stage one - denial.

I merrily continued denying the change to our profession, thinking I was OK and absorbing myself in work. I lost any form of lunch break and gobbled down a sandwich whilst working in front of the computer. I saw an increase in unfunded and unnecessary clerical work, and I did it. At the same time I saw the progressively pitiful practice finances.

But then something changed.

Stage two - anger.

Fortunately I had an excellent focus: a certain Jeremy Hunt. And when I got angry, I got really angry. I took to Twitter, using 140 characters to vent. My non-medic friends grew tired of my anti-JH, pro-NHS posts. I was quite generous with my anger though and shared it around a bit. Any silly DoH/NHS ‘personality’ and ridiculous policy was welcome to it. And frankly, I just needed to read the words ‘Care Quality Commission’ and I felt livid. If I’m totally honest, I don’t think I’m quite over this stage.

Stage three - bargaining

So stage three began, I bargained. How could I, and we, make things better? How could we salvage our profession. Social media galvanised us and new groups were born. We would work hard to come up with new ideas, and we would be spared. If I could work in a different way maybe I could prolong the life of primary care as I knew it.

Then, unsurprisingly, I became really low.

Stage four - depression

Most people who know me didn’t recognise the quiet, withdrawn being in front of them. The depression subdued me. And the cause was clear - a job that had been everything to me had changed unrecognisably. I no longer looked forward to work. I worried about patients and my own ability more than I had before. Every case could end in legal action or a report to the GMC. Every prescription could harm someone. I should have referred patient X, I shouldn’t have referred patient Y. I doubted every action.

Over the past few months, things have changed. Now my grief has ebbed, I’m back to being me again. I still miss the job that I had five years ago, and grieve for it, but my working life will go on.

I wish I could chat to Kübler-Ross though, I think their model is flawed. Stage five isn’t acceptance in this case, it’s determination. I refuse to accept this as an inevitability, instead I choose to fight for general practice. 

Dr Susie Bayley is a GP in Derby and chair of GP Survival

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Readers' comments (23)

  • beautifully put Susie.

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  • Well whem I realised I could not revalidate as the system was not set up for academics like myself, I felt like the doctor part of myself had been killed and died.
    I still do not feel that I have been treated fairly and I have no recompense to anything. I cannot appeal etc... that is it for me.
    While this still hurts, I have moved on but I still support those in the profession I loved and identified with all my working life till now.
    I told the GMC lackey then he explained that there would be no way forwards due to my particular situation (ie being an academic), that this is like a berieval and he was an undertaker.
    The government do not give a monkeys who you are or what you do, or whether you have found a new field of medicine, which I did, they just want you to leave medicine to force the closure of the NHS.

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  • I've accepted it. The NHS is dead. I plan to move on.

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  • Dear Susie,
    Thank you for your post. The NHS is worth fighting for, I agree.
    I'm a Counsellor, my diagnosis of the body of the NHS is that it is ill. My experience of working extensively with addicts informs me that behind many of the challenges facing us all today would clarify with more accurate diagnosis.
    My blogs have tried to provide this diagnosis, though I feel like John Snow trying to convince this era of its bellwether disease!
    https://lifeisreturning.wordpress.com/2014/03/31/45/

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  • The Govt wants the best value for public money. So they will chop NHS finances to ;lower % of GDP [ from 10 to 7 roughly currently]. This is a simple equation really. The question is this= will we continue to get doctors at a pittance.
    The answer is you probably will get enough starry eyed doctors who will live on a comparative pittance for the NHS and the greater good.

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  • The Germans have a word for it " Totalischegefuchlichscheit "

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  • Great piece

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  • Doing well so far but you need to get to acceptance.

    Accept that the NHS is designed to tend towards the cheapest possible healthcare system that is politically acceptable.

    That is the only answer.

    If patients paid your fee for your services you would welcome increased demand not see it as a sign of failure.

    NHS general practice survival =/= general practice survival.

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  • I totally identify with stages 1-4 but my stage 5 was acceptance and consequently early retirement 1 week ago. Stage 6 is relief and contentment and planning a new career.

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  • It's chilling to read this Susie as I was planning to write this exact blog!

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