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GPs go forth

No one likes us – and we don’t care


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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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