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At the heart of general practice since 1960

I still think that doctors should not strike, despite the abuse I've received

Dr Nick Summerton responds to his critics

From Dr Nick Summerton, a GP in East Yorkshire and a former NICE adviser

Leaders of the junior doctors claimed success for the first day of strike action last week. But at what price?

How many people had their lives and work disrupted last week? What impact will the delays in testing and surgical procedures have had on individuals? How much additional distress has been generated amongst patients who are already anxious?

I strongly believe that going on strike is something that doctors should not do

If the BMA does win in its dispute with the Department of Health I worry that it will be nothing more than a Pyrrhic victory. The toll on the reputation of the medical profession will be tantamount to a defeat.

As a doctor trained in the early 1980s I strongly believe that going on strike is something that doctors should not do. Using patients as ammunition in an argument with any employer – public or private – is simply wrong. Sadly when I expressed this view in an interview last week for Pulse my comments were met with a torrent of abuse from many medical colleagues. Hardly the sort of responses I would usually have expected from a group of professionals.

But what concerns me most about the strike, and the responses I have received, is that it seems to highlight a different set of values held by many younger members of my profession. Do they subscribe to the same principles as those of us trained in the last century? If a patient arrives with a problem 10 minutes before the end of their shift would they look after this person or pass them on? If a relative asks to have a chat in the evening during visiting hours will they be there? If a GP asks for a call back will they bother?

I appreciate that caring for patients in the modern NHS can be challenging – resources and time are limited whereas expectations and technology continue to grow. But, looking after patients in general practice would be so much easier if junior doctors could send me prompt and legible information after a person has been seen or discharged from hospital. My patients also constantly grumble to me that they don’t know who is looking after them when they are in hospital, there is no continuity of care, and families never know who to speak to about their concerns.

Over the last few days I have spoken to a number of consultant colleagues, many of whom seem to share my views about striking. One also outlined the difficulties he now experiences in persuading his junior colleagues to work beyond their shifts, even in extraordinary circumstances. Another suggested that there is a requirement for a balance to be struck between working hours and acquiring clinical experience – tiredness certainly impacts on patient safety, but so does inexperience.

In 1985, as a junior doctor, I was severely reprimanded by my consultant for not calling a GP about one of their patients who had died on his ward. I took the lesson to heart and never made the same mistake again. In contrast when I phoned up a junior doctor myself recently to grumble about the way they had discharged a child who arrived at my branch surgery one afternoon from the hospital very unwell, I did not get an apology and nor did the parents, just a letter telling me off for upsetting this doctor.

Two further strikes are planned. But I do hope my junior colleagues will rethink their strategy and consider the broader consequences for our profession of such ill-considered action.

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Readers' comments (47)

  • "If a patient arrives with a problem 10 minutes before the end of their shift would they look after this person or pass them on?" - If acutely unwell, yes. If yet another stable patient, there is literally no point in fully clerking them if someone else is about to takeover. Do their bloods/ECG/order scans, so the wheels are in motion, yes. Wait around for all those investigations to come back and formulate a management plan? God no. This isn't a professionalism issue, it's self preservation. The torrent of patients never ends, and lines have to be drawn. This seems to be a comment from someone who has never worked on a modern receiving unit. The colleagues that I know that did stay behind every shift are now pleasantly burnt out and have fled the country.

    "If a relative asks to have a chat in the evening during visiting hours will they be there?" Yes. Again, unless someone is in extremis in A&E. This is where the bulk of useful experience as a GPST in a secondary care job lies, so I spend hours on this, and focus myself on it when I can.

    "If a GP asks for a call back will they bother?" Yes. And if I can't, as we're as prone to extenuating circumstances and external pressures as the working GP, I'll handover, and ensure it's done by someone else, much like you would if trying to get through to a ward doctor and couldn't.

    The penultimate two paragraphs highlight the issue with your broad, sweeping condemnation of junior doctors - it's based on anecdote. Remember you are a tiny island, floating in the community, with very very limited exposure to the realities of secondary care. You only remember/see/hear about the extreme cases. I have dealt with many issues arising from substandard primary care management/communication, as a receiving doc - predictable adverse drug interactions, patients unaware of diagnoses, potassiums of 5.4 on a Friday evening - but I don't condemn every GP as being unprofessional, because it reflects

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  • (cont. ) an infinitesimally small sample of GP contact. That and the fact that making derogatory statements about professional colleagues in a public forum is the pinnacle of unprofessional behaviour, so much so it's part of GMC guidance.

    I respect you difference of opinion regarding strikes, but please, disentangle it from your biased, sentimental beliefs based on weak anecdotal evidence - further unfounded criticism of an already morale-less population on the cusp of burnout in their mid-twenties is counter-intuitive and damaging to us all.

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  • Wow! Dr Summerton. Complete and total take down by a registrar.
    To summarise-the GP registrar respects your opinion on doctors going on strike (you do not seem to respect theirs) but you should not back it up with anecdotes and your Fallacy of Hasty Generalization.
    Your opinion seems to conclude that 'junior' doctors are lazy and inconsiderate based on your anecdotes. This is tantamount to hospital doctors saying GPs know nothing based on inappropriate referrals from an miniscule number of GPs.
    Well done, GP registrar.

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  • Pulse - please stop giving people like Summerton the time on here.

    Well done to the GPST for posting on here, in such an eloquent manner.

    If you cant take the criticism, Summerton, then dont make broad statements that are derogatory towards those who will be the future of healthcare in the world (if not in this country).

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  • Junior Doctors going on strike for 1,2,3 or more days is actually a relatively small issue ( although it will obviously get massive publicity.) If the BMA lose the overall argument then a whole lot of doctors won't be working for 365 days every year. That's the main issue!

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  • Patient feedback: 'Non recognition of mental health issues,very slow to act on hospital consultants instructions,and failure to diagnose simple tests correctly. I find this shocking and frightening. I can,t say how shocked I am.'

    Matthew 7:5 for you sir!

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  • To be fair, the feedback quoted by 7.22 was about someone at the practice and not necessarily Dr Summerton.
    I don't care if he a fantastic clinician or not. He was incredibly derisory about our colleagues. How he can complain that he felt abused after making such insulting, sweeping generalisations about the junior doctors is beyond reasoning. This latest article is much longer than the original but quantity is no substitute for quality and he is still wrong. Telling us that he has had a chat with some dinosaur consultants is not going to help his argument. The fact is that the vast majority of people were angry with his unjustified comments. So what if he managed to track down a few sympathisers?
    I don't quite understand why Pulse pays him to write these insults. You don't usually expect a trade magazine to publish articles intended to offend its readers. But maybe our profession has become so self-deprecating that this is seen as ok.
    BTW, Well done registrar 5.36 for getting in first with such a well written post.

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  • I DON'T THINK THAT GPs SHOULD BE MEDICAL DIRECTORS OF PRIVATE MONEY MAKING COMPANIES.....WHAT DO YOU THINK DR SUMMERTON????

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  • Dr Summerton appears to have learnt nothing from his first piece, this one is every bit as derisory, and was expertly dissected by one of the very juniors he so evidently has little sympathy with. He is badly in need of defenestration, and I don't care how many consultants he spoke to at the Lodge meeting. I'm glad I don't work with this man. Bad for my blood pressure.

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  • No offence 8.10 but you are a partner which puts you pretty much on a par with a private company director doesn't it?

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