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Gold, incentives and meh

No one likes us – and we don’t care

Copperfield

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Absolutely tragic news for those of us, that is to say, that minority of us, that is to say most definitely not me, who have a deep-seated need to be liked/loved by our patients. Because they aren’t any more. According to the National Centre for Social Research’s British Social Attitudes Survey – and if there was ever a survey on our attitude to survey titles, this would not score well – satisfaction with GP services has plummeted in the past year.

Satisfaction has dropped from 72% to 65%, the lowest level ever. It means that, for the first time, we’re not the Manchester City of the Health and Social Care Premiership. Instead, we’re level on points with outpatients. Yeah, I know, outpatients: a service characterised by incomprehensible consultations, unavailable test results, zero continuity, late running and parking fees. We’re that bad.

Those who could be bothered to raise even half a sceptical eyebrow at this finding were quick to rationalise away its importance: it’s not GPs who have fallen in the public’s estimation, it’s the service in general, and that, of course, is beyond our control. Besides, the public is becoming ever-more critical, demanding and unforgiving, with the older, more grateful and more graceful cohort these days only able to show its appreciation in the form of crem fees. And anyway, it’s pretty obvious the slump in satisfaction simply reflects the prevailing culture of everyone hating everything and everybody more than they used to. Etc.

All of which is probably spot on. On the other hand, the stats might also hide an uncomfortable truth, one that is difficult/embarrassing to articulate. It goes something like this: patients are less satisfied with the GP service because the GP service isn’t as good as it once was, and that’s because GPs are less committed than they once were.

GPs are no longer the Man City of the Health Premiership; we’re now level with outpatients

I genuinely believe this to be the case, and dismissing it as the terminal roar of a burnt-out dinosaur doesn’t necessarily make it any less true. As far as I’m concerned, there has definitely been a fall in dedication and goodwill, a general dilution and anonymisation of care and a decline in, or even scorn for, ‘commitment’.

There are doubtless all sorts of excellent reasons for this, including, off the top of my head, the realisation that there’s a life outside general practice, a move towards more corporate and faceless structures, an awareness that the pact between GPs, NHS and patients has broken down, an increasingly rigid and militant approach to contracts of all sorts, the relentless grind of workload and medicolegal peril, the all-pervading need to wear resilience as a badge of honour and so on, ad nauseam.

So maybe our slide towards mid-table ignominy in the satisfaction rankings represents an opportunity to point this out: perhaps, ultimately, society gets the doctors it deserves. In other words, we care less, and may reach a point where we couldn’t care less, and that’s because we have lives, too. Saying this might not make me popular but, hey, I’m getting used to that.

Dr Tony Copperfield is a GP in Essex 

 

 

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Readers' comments (23)

  • "the pact between GPs, NHS and patients has broken down" - I agree, and you could go further: the pact also involved politicians and the media who maintained the high status of doctors in exchange for sacrifices of quality of life by the doctors. Not any more.

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  • Another excellent diatribe from my favorite GP columnist! Yes dedication and commitment are very passé! Now it is “ Me Too#” and part-time portfolio career futures! New GP’s no longer want the Full-time Partnership model and commitment of my professional life! A loss to them and for their patients

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  • Completely agree. I'm not willing to take on a partnership and offer continuity to my patients as the risk is too great and the reward too small. Would love to if it didn't mean dealing with CQC PCSE and getting done over by retiring older partners with full pension pots.

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  • David Banner

    Brilliantly articulated. A hard uncomfortable truth, but a truth nonetheless. The dedicated vocational full time partners in a job for life are dying off, but the dream job we had in the 20th century has become a nightmare in the 21st, so who can blame the next generation for saying “thanks, but no thanks”.

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  • Would have loved to be one of those Dr Finlay type GPs but those days are gone. A random selection of KPIs to meet each year, private companies winning contracts they shouldn't and constant shifting of all the services around you who seem only to be commissioned on short term contracts.

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  • well you're popular with me and I suspect with many other GPs of all generations! As usual spot on, but I suspect things are now irretrievable

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  • AlanAlmond

    Yup they get the service they deserve. You ain’t got not respect for me, well I ain’t got no respect for you neither. In the me-me-me world where everyone expects everything with zero effort and no personal responsibility everyone looses. Tough shit. Good stuff is earned, it’s not a right.

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  • Vinci Ho

    For those who are familiar with the metaphysical world of Hegel-Engels-Marx , one recalls the mechanism of quantitative increase leads to qualitative changes . ‘Dialectical Materialism’ being used to explain social evolution is still an academic subject.
    That is demonstrated even in the simple example of raising the temperature (quantity) of water up to 100 degrees Celsius , changing it to steam (quality ).
    But the question , however, is ‘ Is steam always better than water?’
    We have exactly the scenario of increasing quantity (more and more appointments/access as promised by politicians ) leading to changes in quality (continuity diminishing , for instance).
    Ultilitarianism ,pushed by economists, falls into the same trap of trying to solve all human disputes by increasing utilities in an economic model .
    The simple and ironic truth in health is : a better health of a nation will result in less input from doctors and nurses(hence, an increase in quality leads to less quantity , instead) ; the true National HEALTH Service .

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  • The pact has broken down all right. The public have refused to vote for a better NHS and have therefore failed to take responsibility for the welfare of the staff running it. We can’t look after you if you don’t look after us. You’ve unleashed the vindictive Tories, who have gone about doing EXACTLY what they always do. The blood is on the public's hands, not just the politicians.

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  • Healthy Cynic

    Excellent column Copperfield. Why is it that we feel we are fighting against NHS England constantly in order to provide a good service to our patients. Aren't we on the same side?

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  • The majority of the public have no understanding of the crisis that primary care is facing. Their concern is primarily that they want to see a GP when they want and to be able to see their 'regular' dr.
    They actually blame those of us actually still working in the system if they can't have what they want and seem oblivious to what we as a country are facing.
    Be rude to us often enough and more will leave then they will not be able to say 'I'm not seeing the ANP or paramedic or whoever because it's my right to see a GP'
    The level of ignorance is incredible.

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  • Spot on Copperfield! We salute you!

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  • Brilliant and spot on as usual. And terrifying because respectful understanding grateful patients are the bedrock of a well functioning practice. Once goodwill is eroded it doesn't come back easily

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  • Totally agree, my registrar has been offered a job at the practice, she admits she loves our practice but will only commit to 2 days as a salaried GP. No kids, no reason for this other than work/life balance? I guess when she has kids she will go down to 1/2 day... if that. Not really sure where we are going when a perfectly excellent registrar does not want to work more than 2 days a week.

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  • The only thing being a clinician in the NHS is being a patient: fighting to get an appointment with a GP, working one's way through the treatment algorithm designed by the CCG to keep patients away from expensive options...
    It would be better the NHS accepted that it can do a limited number of things well and stop pretending it can offer all services only to restrict them to the point of a theoretical option. Treat all stakeholders as adults and ask if people are prepared to pay the money required for a great system or whether they'd like a simpler, but cheaper one.

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  • Thank goodness we are not like Man City. Nobody would like us.

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  • Dr BG's case illustrates it perfectly. Go to work and cover 4 other colleagues, no IT, no breaks, no food, no backup and then get done for manslaughter. We GPs have begun to be inured to the DM diatribe Lazy and overpaid. When I come off an 80 hour on call shift in GP land with 3/4 hours sleep and get called lazy, we begin to realise no body cares for us and the hours we do. So, the UK will get the GP service they deserve because they did not understand what we did in hours of on call to keep it going.
    Frankly, I would not be a doctor, never mind a GP in the UK.

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  • Absolutely on the nail Copperfield. I struggle with this vacillation myself so forgive my taking the time for the essay to follow( I’m retired!).
    I am deeply proud to have been a GP and of the ‘old style’ form of practice to which we devoted our lives but knowing that that same system demanded everything of us unreasonably. This eventually stole my health & nearly killed me in my surgery chair -quite literally.
    We should want GPs following behind us to expect a better deal where they will work to equally high standards and be dedicated & committed whilst ‘on duty’but where workload,pay and conditions are vastly more reasonable ,leaving them with sufficient time and energy for themselves and their families.
    We dinosaurs are of an era where it was expected by others ,and therefore ourselves , that we give our total commitment to the job, and never say No. We’d strive for excellence & continuity no matter what and leave the premises only when every last task was achieved , ( to then log on to the remote computer link from home after a quickly snatched supper for yet more hours of test results, hospital letters , reports & admin).
    I believe this willingness to subsume ourselves hails from the 2 in 1 hospital rotas we survived and the conspiracy of silence surrounding the effective running of the hospitals by JHOs & SHOs . We worked through often very poorly supported 9am-5pm hrs to then face far too frequent out of hours sessions with the Reg ,SrReg and Consultants all absent from the frey & on call from home -barring the 10pm & 8am ward round ( & God forbid you didn’t have an extremely good reason to disturb them).
    That we had almost no sleep for days on end and rarely any decent food available added to that toxic mix. We never dared to complain because that was just how it was..put up and shut up and wear your exhaustion with pride.
    All these years later things remain far from perfect however. Hospital rotas may have moved away from of the dark ages of 1:2 towards shift patterns ,despite laments that this is at the cost of continuity and experience ( we oldies might say the type of experience you can do without though). But that Dr Bawa Gaba, & 2 of her nurse colleagues suffered much of the same systemic failures, were left exposed & then shamelessly offered up as the responsibile scapegoats suggest there is still a very long way to go.
    However the expectations of younger doctors have changed and they are no longer willing to put up & shut up and tolerate unreasonable work practices..nor are their defence societies...good on them and long overdue !.
    For us moving into General Practice way back then it seemed an improvement, for a while, because of the illusion of control as a GP, especially once a principal.
    But the reality eventually dawned on most that we dinosaurs have no control, there is no stopping the torrent of work & expectations & that resources and support will continue to be withdrawn or eroded & , for many, our income falling way below our consultant colleagues.
    Hence modern day GP has become a ‘not-so -golden -handcuffs’ scenario with many of us trapped & risking ‘last man standing’ personal financial devastation if we follow the other exhausted GPs stepping off the treadmill. (No such risk if juniors choose a hospital based career or non principal GP career...no wonder we can’t recruit !),
    The exponential increase in workload and responsibilities over the decades since we started out and the ever shrinking levels of investment and support eventually took its inevitable toll on many of us with burn out and low morale rife and early and ill health retirements now souring. We were all behaving as King Canute ,deluded that we could stop the incoming tide.
    The later cohorts of GPs amongst us have witnessed our earnest committment, hard work & dedication being repaid with an endless ratcheting up of workload pressures , worsening resources and falling income whilst simultaneously being regularly denigrated by the government ( amongst others) for our efforts and cheated of much of what should be our private time.
    Who can blame them if they do not wish to join us on the ever faster and unreasonable treadmill that is current General Practice and certainly not as Principals .
    Thank goodness for those of us who ,despite all the negatives, still love the job, have a fascination for medicine and for people and who continue to cope against the odds with huge responsibility and a high pressure workload.
    I fervently hope the BMA ,LMCs GMC and the various royal colleges will act so that no doctor is overburdened and under resourced or unsupported . Nor should we allow any back sliding to the ‘stiff upper lip approach’ to what have essentially been abusive working practices nor tolerate the ( ludicrous) complaints that the doctors are not ‘resilient’ enough if they point out the unreasonable demands or conditions they face (& after Dr Bawa Gaba’s experience more will rightly do so).Rather, let’s see that our representatives work to ensure Doctors have the time, tools and conditions to do the job they love to the high standards they espouse & with commensurate remuneration.
    End of rant!

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  • Perfect as always Copperfield! And for those of you who want the T-shirt you can get one from Millwall FC supporters shop as the club chants from the terraces are “no one likes us we don’t care”. I’ve had the T-shirt for years and years and proudly wear it under my shirt! It has helped me keep sane! Go on you lot and splash out on one !

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  • Vinci Ho

    'Ask not what your country can do for you - ask what you can do for your country.'
    Remember this president sworn in from Kennedy in 1961?
    For those older(even older than me) , loyal , resolute and dedicated colleagues, this motto(or at least, a slogan ) carried , more or less, some meaning. Replacing the words 'your country' with 'general practice or NHS' , perhaps , would be even more appropriate. That was then , this is now. May be , when you have something that you believe was 'precious' in your hands , you will prepare to 'die for it'. For these colleagues, there are no words other than 'Salute and Respect ' from me.
    After seventy years of NHS , our younger colleagues, sadly , are forced to accept a different reality and clearly ,ethos . The most discouraging part is when we are increasingly seeing politicians passing the blame to us for a failing NHS caused by themselves ;Doctors got prosecuted and sent to jail because patients died under a failing health system with resources well starved . If you think this is an exaggeration, we are frankly not far from this 'destiny' . I accept that some would say , 'Oh ! we cannot keep throwing money into NHS , we already have.' But that is exactly my argument that many economists had been trying to solve human disputes by constantly reverting to economic models , one after another. So called 'productivity' has a different meaning in a health service like NHS to that in other industries.
    Bottom line is , we do not need a heavily politicised NHS and its gatekeeper. As I wrote recently, those fundamental questions of whether we still want NHS , precisely how to fund it directly and what it is to cover , need honest answers from a government. Politicians are only to be blamed for this failing NHS simply because they have been deliberately avoiding these questions.
    For many of us ,sadly , like the title of Dua Lipa's recent hit (my favourite) :
    IDGAF.........

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