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At the heart of general practice since 1960

What is our currency?

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My kids have been able to define the word consequences since the age of two. When they were very little, tantrums and fighting would lead to the naughty step. A little older and they were banned from treats. Nowadays it’s a ban on screen time and puppy training. I am always on the lookout for new currency I can bargain with, in exchange for correcting inappropriate behaviour.

I am writing this as I reflect on events over the last few days at the annual LMCs Conference in Edinburgh. It was only the third such conference I have attended, so although not a virgin, I was still a relative newbie. In spite of this novelty, it was all starting to feel a little bit like Groundhog Day.

There were the usual faces lamenting the usual topics – indemnity, funding, workforce, over-regulation and demand. Motions were passed, as in previous years, never to be mentioned again until the following year. All in all, it appeared we were voting on sentiment, as opposed to any action.

So why is there no action? What is our currency to manage the bullying behaviour of our current government? Motion S20 from last year’s conference – demanding that GPC ballot the profession on potential action including mass resignations – was one form of currency which was followed through only by our Northern Ireland colleagues. So why do we have unanimous support for certain motions, only to find them archived in the LMC libraries?

The answer is depressingly simple. We have lots of currency but no consensus. Imagine my kids being told they have no more tablet time for the week, only to find my husband has lent them his iPad. The resulting behaviour is likely to require the services of Super Nanny.

If it takes two whole days for only 300 GPs to pedantically debate the fine print of these motions, how on earth can over 50,000 GPs reach a consensus about what our currency should be?

A recent unpublished GPC survey confirmed the dysfunctionality of our profession. As a form of protest, the majority of GPs rejected the notion of stopping non-core work; work we are not even paid for. So forget undated resignations and an out-of-hours boycott – these guys won’t even stop doing the pre-op work up, which forms part of the hospital tariff.

So where does the fault lie here? Is it down to the greedy and self-centred GPs who cannot see beyond their own noses, or is it down to a pitiful lack of engagement by many of our leaders? And as an LMC board director, I now include myself in the latter group. I was merrily discussing, debating and voting on motions but not once did I stop to consider how my constituents would like me to vote.

So I’m caught up in the classic dilemma of a politician – do I make decisions by committee, or have I been voted in to use my own values and beliefs to represent my constituents?

I guess it all comes down to the different facets of good leadership. The right hand needs to be listening, communicating, engaging and collaborating. But the left hand needs to be strong, decisive and brave. It’s only when these two hands come together in an embrace that the masses will follow.

We need our very own Super Nanny to bring the profession on side, whilst showing this government who is boss. And even then, there’s no guarantee it will work because we are a divided profession.

So whatever our currency is – we need it to unite our profession. Without this unity, I fear our currency will tumble further than a post-Brexit pound.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (8)

  • I love Groundhog Day - my favourite movie. Unlike GPs, Bill Murray does at least DO SOMETHING to improve his life.
    I think that the vast majority of GPs will just carry on, subconsciously enjoying their suffering until something major happens - eg, burn out/depression on a personal note or imposition of salaried status at 50% of pay on a profession-wide front.
    So funny when he's doing the jazz piano solo.

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  • There is an invention that solves this - it's coincidentally called 'currency'!
    It has been shown that using 'money' to 'pay' for things helps resolve the complex individual supply and demand preferences for different services, provided at different times, by different individuals.
    It even ensures the funding increases if there is more demand for a good or service! No central planners needed. Magic!
    There is an alternative system called 'communism' that prefers wise central planning instead of 'money'.
    Many countries have discarded communism as a way to allocate resources, as it leads to shortages and deaths, although it can still be found in some parts of the world, such as the United Kingdom's NHS.

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  • Or you could follow the "capitalist" American system of healthcare where you spend 18% of your GDP and leave 40% of you population without cover. Most civilised countries follow some form of "social" planning-dare I say Socialist!
    Can't run good healthcare through market forces (although we know the self serving medics end up richer!)

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  • I'm not sure why moving away from one of the most centrally controlled socialist/communist health care systems in the world means you will end up in the USA!

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  • Azeem Majeed

    Thank you Shaba.

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  • Vinci Ho

    Since you mentioned leadership, I am tempted to use my favourite quote from Game of Thrones again:
    ''!Do you know what leadership means, Lord Snow?
    It means that the person in charge gets second-guessed by every clever little tw*t with a mouth.
    But if he starts second-guessing himself , that is the end, for him, for the clever little tw*ts , for everyone.
    This is not the end, not for us, not if you lot do your duty for however long to beat them(enemy) back....''
    Ser Allister
    GOT S4 ep9

    Of course , Ser Allister was then executed by a resurrected from death(murdered by Allister in a mutiny) Jon Snow a couple of seasons later .

    Reality of politics........

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  • you will never change it. it will destroy you first.

    get out and work for an hourly rate and look after yourself. obviously be a good doctor too.

    the system has destroyed general practice. youre on your own...

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  • ZX81

    The reason we are powerless and can't agee on 'how to' or even 'if' we should resist is because of who we are. It's a direct result of the current stock of UK GPs. There is a process of natural selection at work and it is painfully expressed in one of the major issues facing the profession - the lack of people who are prepared to work as GPs. People are leaving/retiring/ locuming and leaving the country. The people who do this I suggest are those least inclined to put up with the status quo...the ones that are left are the ones who are prepared to carry on...people who don't want to make a fuss, or feel they aren't really worth very much or simply don't have the guts to stand up for themselves...or are trapped and can't. I'm not saying everyone but as time goes by the proportion of passive folk increases as the 'I'm worth more than this' folk leave. It's kind of inevitable and I'm starting to believe we've crossed a tipping point and by and large we're increasingly a rather pathetic gutless bunch happy enough to shrug collective shoulders and watch the progression disappear. I don't believe we couldn't do something to make the government wake up ...we're just to limp to all agree on doing what's required. That's us ...no one else

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