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Independents' Day

The good, the bad and the ugly of general practice

Dr Samir Dawlatly



General practice in the UK, and England in particular, is in a right conundrum. We just don’t know how to describe ourselves. On the one hand, there are the well-documented, blogged-about, discussed and reported issues around workforce, workload, funding and regulation. It is easy to have a moan and point out all that is not well with the profession. But at the same time, there is a concerted drive to recruit more unwitting doctors to this profession, that seems to have been perpetually in crisis for over ten years.

Before I even started training as a GP, I asked a GP what he thought the biggest threat to general practice was. It was a couple of years after QOF had been introduced and his answer was: ’Nurses. They are going to take our jobs.’ Even the wisest of GPs don’t have a crystal ball or the ability to predict the future.

The ability to declare a crisis has undermined general practice for years. I can almost hear Matt Hancock Skyping one of his advisors: ’What? A crisis? But didn’t they say that last year? And the year before that? What’s it about this time? Well just tell them we’ll find an app for it and give them some money to rearrange their deckchairs…’ We all know that a crisis is not a crisis until someone rich or famous dies.

So, we are left with a profession where a large chunk are doom-mongers, but don’t know how to do anything about it. And if they make too much noise about it they’ll get a sharp elbow and a seething rebuke: ’Shut up with your moans, you’re only going to make the workforce crisis worse.’

The ability to declare a crisis has undermined general practice for years

And while the nihilistic realists try to decide whether to be honest about their workload, the mindless optimists at the other end of the spectrum are gleefully unpacking their online video consultation apps and networking in their networks. After all, John J Kennedy famously said, ’In a crisis, be aware of the danger - but recognise the opportunity.’

In the week when mainstream media was running Pulse's stories on GP workload and workforce issues, before they were shunted from the public consciousness by Brexit, scandals and other clickbait, I ran a workshop for medical students on general practice as a career. I was honest about the good, the bad and the ugly of general practice. They had plenty of questions and managed to stay awake despite their hangovers (they had their exam results the day before).

I wish I had the solutions, not just for the students, that would fix general practice, especially for keeping hold of new recruits and wise older hands. It’s great, it’s crap. It delights, it frustrates. It defines, it destroys. It’s a conundrum.

Dr Samir Dawlatly is a GP partner in Birmingham

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Readers' comments (10)

  • Samir, most of the good comes from the part of the job that does not involve the state hugely - patient interaction, what we are trained to do. Most of the bad comes from? You guessed it, state regulation. We've known the solution globally for decades, but we've allowed ideologues to indoctrinate the young and the public to the Left, to the detriment of all. The solution is libertarianism, the freedom to bear individual responsibility, which is what gives life meaning. And the reduction of the state to the bare minimum, as power corrupts.

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  • Carthago delenda est

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  • Dr Death.... how about NHSenglando delenda est?
    I think Samir reflects the dilemma that many GPs find themselves in ...what to do? Your career is going to **** you can see it getting worse by worse, day by day, the ship is sinking but what do you do? But you dont need to have the solutions Samir as you can't control the situation.... the people who can effect change are ineffectual......The solution is for us not to work for the NHS anymore.... emigrate, retire, retrain.... our leaders are not getting us anywhere but around can't save the job but you can save yourselves!!!! I would recommend emigration as your best bet if Im honest.....

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  • If you are young enough curious,ther are are lot of us caught in the middle.

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  • Slaves chained to the Galley as it sinks with to many people beating the drum trying to get us to row harder.Still we sink.

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  • Hi turn out the lights... I went to Oz in my 40s.....

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  • Out of interest, Dr Ho, prior to the (great folly) of the NHS contract with GP in the late 1940s, as you say by the Marxist Left, GPs were 'free' to set their fees and offer discounts or no-charge to the 'deserving poor' etc etc, but what are your views of the resulting closed shop of professions. Even in the golden age of UK GP say in the 1990s there was a closed shop which strictly regulated who could open a practice and when and where, and that was regulated by GPs themselves

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  • Hi Batman, yes I've come across that in my reading. Obviously, monopolies/licensure/regulation is a restriction on the 'market'. Friedman's suggestion of de-licensing healthcare entirely may be a bit too much for some, and even myself. These days we have anti-trust laws that are good but seemingly don't recognise all monopolies e.g. the NHS, but may apply IF we go to true private healthcare provision. I am of course totally against monopolies, but I'm not entirely sure yet if I would leave the maintenance of standards say to the royal colleges and medical schools, or the 'policing' of doctors to the civil/criminal system. Would be interested to hear any thoughts on it.

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  • strike action, its the only option left to protect our patients.

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  • Samir,please allow me a variation of your Clint theme. Not long ago you offered GPs some tips how to spice up their lives and boost their income. “... there are more opportunities to work for a CCG, a provider network, the local super-partnership, as an appraiser, CQC inspector, mentor or GP health advisor. Other posts for NICE, the RCGP, LMC and BMA can also be applied for…could moonlight for one of many digital private healthcare companies…”
    Thousands have followed your advice and are doing very well indeed, for themselves. Some of them will also appear on the Pulse Pantheon of Influential GPs (the good).
    The downside is that the rest of us (the bad) have to work more for less, and (the ugly side) "GP numbers will fall 7,000 short within five years despite increasing trainees" : Pulse 21 March 2019.

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