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GP workload is a matter of life and death

Editor’s blog

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The LMCs Conference in Belfast last month, which determines the policy of the BMA GP Committee for the following year and therefore affects the whole profession, was a pretty staid affair.

GPC chair Dr Richard Vautrey’s speech was based on having ‘listened, acted and delivered’ in the four countries, especially in England on the new contract.

A number of speakers on stage referred to the first genuine sense of optimism they have experienced at any conference in recent years. Controversial motions criticising the primary care networks introduced by the contract and calling for a radical change in payments to reward activity rather than list size were abruptly shot down.

I know such optimism will surprise many grassroots GPs (and even some who attended the conference). The new contract in England does little to cut immediate workload, and there is no guarantee the shift to networks will turn general practice around.

But the conference was dominated by a speech by Dr Lucy Henshall, from Suffolk LMCs. She told everyone the tale of Richie, a friend of hers from medical school and her husband’s practice partner.

‘As a GP trainer, he inspired a generation,’ she said. ‘Astute clinician, compassionate, skilled, and a joy to work with.’ But she added: ‘General practice made Richie ill; he needed two lengthy spells off work for depression. A complaint landing just as he returned from a family holiday had changed him irreversibly.’

We do know that being a GP does not help people's mental wellbeing

In December 2013, Richie died by suicide.

It would be irresponsible to assume a single cause for suicide. But we do know that being a GP doesn’t help people’s mental wellbeing.

Dr Henshall gave stark figures: one in three GPs suffers burnout, depression or both; female doctors have four times the suicide risk of the general population; and the average age of GPs accessing England’s GP Health Service is just 38.

We know complaints are not subsiding. The tendency of health managers to dump more work and blame on GPs continues, as our cover feature on antibiotic prescribing testifies (see page 6).

But most importantly, workload has continued to increase since Richie died.

We will be releasing the results of our workload survey next month and we will be taking action.

But we also want to see people with power step up. We know GPs are hard to find, but there are things that can be done. We want commissioners to be compelled to introduce measures to prevent GPs working above safe limits. We want them to actually implement the NHS standard contract, forcing trusts to offer a new referral instead of sending patients back to their GP, with more than a slap on the wrist for those that breach this.

I will not apologise for banging on about workload, because it is the overriding issue facing the profession.

Workload must the GPC’s priority for all four nations this year and the rationale behind any initiative. I fear the requirement to be registered as part of a network in just six weeks’ time, for example, would have to be halted if we applied this thinking (see page 14).

Because GP workload is a matter of life or death – and not just for patients. Until we’ve addressed this, any optimism must be tempered.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk

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Readers' comments (8)

  • Thank you

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  • When your professional body says that you have been listened to but the profession itself does not feel that this is the case then there is a big problem.

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  • Why don't we see headlines like these from secondary care? I've been told that its probably because of the innumerable infighting that goes on there while the GPs hunt in packs. They need to learn from mother nature and evolution as to which species were most successful in surviving.

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  • Vinci Ho

    Is GP networking a Trojan Horse ?

    Desperate times need desperate measures.
    On the land of politics in our country, nothing is currently more controversial than the cross-party discussion of the direction Brexit will take place between Labour and Conservative parties .
    For our beloved GP land , the formation of GP networks is the main theme of this new five-year GP contract . The price tags have been allocated but we are yet to see the actual money as far as the bookkeepers of the networks are concerned.
    Finally , in the fantasy world of Westeros( Game of Thrones) , we saw the incest-bound union(more appropriately mating )between Daenerys Targaryen and Jon Snow , the relationship of whom we know now as aunt and nephew.
    All parties of interest in these three worlds have one thing in common : their fundamental relationship is potentially competitive and antagonistic with the risk of serving as anathema to each other .

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    Like every new ideology appearing on the horizon, we should lay aside our prejudice for a minute and welcome it with open arms. But that , certainly, does not mean questions are not to be asked . My LMC Secretary once taught me, ‘ Do not ask the question in politics unless you knew the answers.’ So there are some questions worth considering for this notion of GP networking:
    (1) Can member practices in a network live happy ever after ?
    As I wrote before , it is difficult for five GP partners in a practice to agree unanimously on certain issues , how hard is it to be in a network covering 30-50,000 patients. Always remember the trilemma principle:- amongst sovereignty, integration and democracy, one can only have two out of the three but never all of them.
    (2) How can the new resources injected into GP networks from the governments be evenly and fairly distributed? For example, for pharmacists , physician assistants , physiotherapists , how much time should they spend in each member practice every week? And when it comes to the new money and how to spend it; well , the caveat is in fact , a potential civil war within a network?
    (3) Perhaps , that is why ‘super-practices’ come into the equation . They provide the governance to save your headaches and settle disputes with your fellow network members . Actually, this is an extraordinary phenomenon simply because the government refuses to equate super-practices with GP networks. Bottom line is , it wants to move away from investing in GP practices individually . Will this create another complex behemoth of bureaucracy stifling flexibility and hence , efficiency? What is the natural history of these big monsters eventually?
    (4) We need the new money to address this current crisis of shortage in resources. We have been starved of tools to provide the current services . The objectives of this new contract , however , appear to be , by GP networking , widening the ‘dumping ground ‘ for more work to be thrown at us from all directions. Yes , you are giving us some new tools but these are easily outweighed by the number of new tasks waiting on the line . Where is the STOP button ?
    5) Hence , last but not the least , GP workload . I am yet to be convinced that the government actually understood how heavy our daily workload was before it sat down to negotiate this new contract with our representatives. Because not too long ago , its propaganda media( you know who!) was still bashing and condemning us as lazy , ignorant and irresponsible ( the tone might have been changed after the Big Boss stepped down ) . If it was not for some strident figures showing a dramatic drop in the number of full-time equivalent GPs in the country ( all four nations) last few years , do you think we would have had this conversation today ? Crisis , what crisis? Remember that ?
    Having said that , I understand from listening to our BMA colleague during a recent roadshow that the new contract is subjected to some path-finding and self-correction as we move down the road . But this can only be credible if the government is receptive and shows some humility.
    Hence , I am looking forward to see Jaimie’s new born baby called GP workload survey report .
    xxxxxxxxxxxxxxx
    Step by step
    Heart to heart
    Left, right, left
    We all fall down
    Like toy soldiers
    Bit by bit torn apart
    We never win
    But the battle wages on
    For toy soldiers

    Too many of our colleagues have been burnt out and fallen down . Is it my fantasy that all toy soldiers can , one day , unite together as a true army to resist our enemy who is always trying to divide and conquer us ?

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  • Done "burn out" and even 7 years ago thought of looking at trying for retirement on medical grounds.

    Suffered it since and a whisker away from thinking about it again, though only good news is my latest total rewards statement.

    This isn't what I signed up for in 1986 on graduation. Its now a shite job, in a shite work environment with absolutely no redeeming features.

    I feel sorry for the youngsters.

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  • The situation is desperate

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  • If we vote for list size rather than activity payments, then workload is entirely our problem.
    I cannot understand the mathematical logic when consultation/ contact rates have trebled in 15 years per patient.
    We are the authors of our own misfortune.

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  • The job was slowly making me miserable. The GP environment in the UK is increasingly toxic and being dragged unwillingly into medical politics and service redesign was not what I signed up for 10 years ago. So I left for Down Under. Best decision I ever made. I’m sorry to say UK GP needs to burn to the ground before it can be reborn from the ashes. The absolute vacuum of leadership from our seniors is a scandal, but to those waiting for it to change, you are wasting your time. Act, do not simply hope for the best.

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