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Independents' Day

Mind the generation gap: Why GPs need to stick together

Letter from Dr Rebecca Jones

Last week, Pulse published an article which provoked quite a reaction, and really got me thinking.

There were a couple of clear messages which could be gleaned from the comments on Pulse and on the GP Survival Facebook page. The first was that young GPs shouldn’t be taking it upon themselves to try and tell their more seasoned colleagues how they should be working or feeling. The second was that ‘leadership’ programmes are distrusted by many GPs.

My take on the blog was that it was an attempt at wry humour; a tongue-in-cheek article which meant no harm, but whose publication was misguided and caused much offense. I was surprised at the negativity which ensued, but many would say it is obvious I would feel like that, being a young GP having qualified only two years ago.

At first I considered that new GPs should be very careful about teaching our grandmothers to suck eggs. I’ve had some of my greatest learning experiences working with more experienced GPs, not just clinically but politically too. And I don’t think I would be as interested in medical politics if it wasn’t for those mentors who have guided me. But I think that respect has to go both ways, and the negativity towards the young GP who tried to write a light-hearted article was quite saddening to read.

I recently worked with a GP who was close to retirement, and although I was just starting out, we had a wonderful working relationship, learning from one another in different ways. I always valued his take on situations, and when I was unsure about something, he always welcomed my knock on his door. I often felt like my lack of experience was glaringly obvious, but he would often compliment me on my style of working, or come to me for my opinion on a case. As this was my first experience of working in primary care, it never crossed my mind that there is a chasm between those GPs just starting out, and those who have been working for many years.

Newly qualified GPs are entering the profession at its lowest ebb, and are learning from their older colleagues just how bad things are, and rightly so. So rather than seeing the reaction to the article as GPs having lost their sense of humour, it should probably be perceived as a sign of just how bad things really are in general practice and just how much our senior colleagues have been through.

But rather than cynically judging those new arrivals for taking places on leadership courses as professional climbers, perhaps they could be viewed as trying to make a difference, but not quite knowing how. I would hope that anyone completing a leadership course wouldn’t claim to know how to lead their colleagues just yet, but would be aiming to equip themselves with the skills to know where to start.

None of us knows where general practice is headed, and I think we’re all scared. But I hope we don’t let that fear divide us. All I know is that we have a lot to learn from one another, whether we’re young and naïve or older and experienced. And when the media and government are disrespecting us, let’s stick together and support one another on our different paths through this uncertain time.

Dr Rebecca Jones is a GP in Hastings and GPC Sessional Subcommittee South East Coast Representative


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Readers' comments (15)

  • Couldn't agree more Rebecca. Respect cuts both ways and needs to be earned.

    One of the reasons I love training is because I learn loads from my trainees and they keep me young!

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  • Vinci Ho

    I actually gave Sarah five stars if you read my comment.
    I know some of us do not think we should be like soldiers fighting this 'war' but we are where we are.
    We recognise our common enemy too well by now and will not go down without a fight Altogether : young or old , salaried or partner , primary or secondary care .......

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  • As a writer you have two choices; write about what you know or guess. Doctors in training writing about what it's like working and how we should behave is the latter. Don't be surprised by the reaction. Tell us about training or starting out - don't tell us how we should work or think.
    Leadership training in the NHS is self selective; you apply. True leadership skills are developed. Sure, learn the skills to develop them but you're not a leader until someone wants you to lead them.

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  • Written like a seasoned pro...... a productive and thoughtful article which is much more likely to get consensus. Utilising simple management techniques, such as showing an understand of the relative parties positions, and agreeing common ground....
    I don't think you should feel saddened however, the author of the article you have alluded to will have learnt a valuable lesson, in a relatively safe environment, whether or not it is perceived that way. Many GPs are at the edge of their tether. To come in with such an article when hard working, well meaning professionals (Male/female/gender non-binary/ all ages) are stressed out over the rapidly deteriorating conditions over which they have little or no control, but yet are held accountable for the results of, and when they feel let down by successive leaders who've failed to actually achieve anything despite what I am sure are well meant intentions (Im trying not to mention the colouring book...Im really trying) and to basically be told that they are being grumpy over nothing and are old dinosaurs incapable of new tricks, was bound to provoke a strong and negative reaction, no-one should have been surprised by the reaction. The RCGP is viewed by many as out of touch. Politics is a dirty game and our leaders are quite frankly too polite and too 'accommodating' to make a damn bit of difference, they don't have the backgrounds needed.... there's an old saying, 'the more unreasonable you are the more reasonable a settlement you get'. This is why I feel the RCGP should be educating the public, not wasting its time talking to the government, and they need to learn the art of 'populism warfare'. A young blood coming through all pro-RCGP who isn't full time at the coal face and getting flippant with the full timers who've been at this game for years and who have sweated blood and tears keeping their service running, what did you expect?..... its not rocket science....... I left the UK because of my reading of the situation and still believe it will not get significantly better for the working GP (not in my working lifetime - lets say another 20 yrs) unless the system is allowed to completely crash, because it is only then, will (a) the public notice (b) the government be forced to do something when they realise all other options are much more expensive and they are going to loose too many votes. I feel the RCGP should have been, and should be today, like they are in Northern Ireland, be rapidly moving forward with preparations for the end of General practice as we know it. They should be publicly cautioning students from entering the profession on the basis that the government seems to have it in for the profession, and the future is 'dubious' for them but if they really are insistent, they will still be trained. The fact the RCGP would stand up and say 'don't do it- the governments out to destroy it' would get news headlines. GP trainers resigning in mass numbers as they 'believe' the government is out to destroy it, would get headlines. We need to stop working with the government and start working for our members, colleagues and ultimately its the patients, who stand to loose most if General practice goes. Desperate times call for desperate measures. Our leaders do NOT have what it takes . We'll still be in this mess 5, 10 yrs down the line (well actually I won't, Im out of it, thankfully) Sticking together will only be useful if there is an actual plan.... otherwise you're simply being herded together like lambs to the slaughter. I don't want you to take offence from that.... Im pointing it out as we don't need any more words.....we need actions. Im going to finish this with the words of Winston Churchill (Again a grumpy cantankerous man, would likely get 5 stars here, I wish he was leading the RCGP)- "You have enemies? Good. That means you've stood up for something, sometime in your life"

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  • Hear hear Mcdonalds medicine

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  • Fair comment Rebecca.

    Maybe many of us have become disillusioned by decades of cynical abuse from many outside parties and also indeed from our so-called colleagues with ambitions to climb some slippery pole. Leadership skills can undoubtedly be honed but there is a certain innateness to leadership which many individuals in positions of power patently do not possess.

    Ambition for personal and professional advancement is laudable if undertaken with some parallel social commitment. Shimmying up some greasy while abandoning all principles, including ones professional mores, scientific stringency etc is not leadership.

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  • Cobblers

    If you read my comment I expressed concern as to what had possessed her to write such a blog? If you have little experience it is sensible to not poke those who do have the experience with a sharp stick, humorous or not.

    That you have come in with waves of emollient suggests that the reaction (which I am sure she expected) got a bit much and she has retreated into her sanctus sanctorum.

    I did suggest getting outside into the sun and expanding the lungs a bit. Having a break.

    I stand by that. Mind you it's now raining.

    Meanwhile Dame HSL professes worry at the increasing time it take to see a GP. Suck it up lady as it's going to get worse.

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  • This is a well written, insightful comment on the responses to a satirical blog written last week which intended to hold a mirror to readers of Pulse, presumable to aid reflection.
    We are living through a very polarised period which is reflected throughout society be it the Brexit vote, left-right political agendas, the young being pitted against the elderly etc and the venom of this divide can be seen on a multitude of media outlets where the public can have their say. I guess GPs are no different.
    I do not see this as a struggle between young, wet-behind-the-ears newbies versus battled hardened, weather-worn, cynical old pros, but more a difference of opinion on how best to confront the present challenges and secure the future of the profession. One route sees the potential for sunny uplands if we as individuals or a as a profession try to go for as many small wins as we can whilst rolling with the blows that comes, aimed at the profession, from external forces on a perpetual basis. The other sees any attempt to impact on events as being pointless, will make no difference and we should all either resist,resist,resist, or find pastures new, preferably in the antipodes (though failing that Canada will do).
    Of course both view points are valid, and despite how it might seem by reading Pulse comment boards, probably held in fairly equal measure to a greater or lesser degree throughout the profession, depending on your personality, constitutional make-up, and levels of masochism!!

    I saw the blog in question as trying to represent those who hold the former worldview, who also read Pulse, but I am sure would only very tepidly venture to make any significant contribution to the debate for fear of being hounded off the board (e.g. the non-newbies Ivan Bennett & Claire Gerrada over the last couple of years I have been reading Pulse). And no, its not because this cohort of GPs are timid wall flowers, but more likely they think why bother entering the 'echo chamber of the cantankerous' to be shout-down with constant negativity - let them wallow in their self-pity.
    Whilst strong impassioned argument is expected and should welcomed on a professional site such as this, the level of vitriol directed at anyone who does not conform to the 'world is falling in, we're all going to die, I tell you die' brigade is truly disturbing.

    If your reading this Sarah, good luck with your blogging and the leadership course. As the young and hip would say - do you, forget the haters and dissers, and above all remember - illegitimi non carborundum!!

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  • "I have returned from Germany with peace for our time" said the optimistic Neville Chamberlain, it was the cantankerous Winston Churchill who gave the leadership that was needed......
    I have cut and pasted this from a 2010 article. If you are into evidence based medicine then You, yourself and You needs to read this and take note before condemning whom I would term the realists, and if you are going to use the term the 'I tell you to die brigade' then you have not learned your people skills, as its seems rather hypocritical to deride these people for being offensive without considering their views, which is what you are accusing them of.
    Here goes...not my words....
    "In the workplace generally positive employees are lauded and the negative are derided. Positive employees are seen as team players but negative workers are condemned as outcasts.Opponents of negative thinking vehemently believe it’s impossible to be both negative and happy. The truth, however, is that negative thinking can have a positive influence. Evidence of this was found in studies conducted in recent years by the University of New South Wales.
    The researchers discovered that negative people communicate better, think more clearly, make fewer mistakes, are less gullible, and are better at decision-making. The reason? Negative people have enhanced “information-processing strategies”, which means they use the critical part of their brain more successfully than cheerful people.
    Im quoting evidence base for supporting the analysis of those who have a negative view of the future of the profession (Not the actual job), can we have the Disney, sugar coated world version as to HOW they envisage it will get better beyond a tepid soundbite about - 'One route sees the potential for sunny uplands if we as individuals or a as a profession try to go for as many small wins as we can whilst rolling with the blows that comes' - can you actually elaborate and try to engage wth those with contradictory views as opposed to just criticising them for being negative? Or will you just quote some motivational poster you've swallowed in the hope that things will get magically better on their own?

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  • It seems I can no longer add a comment to Sarah Merrifield's original blog, but will do just as well here.
    I can feel much of an anger-driven sarcasm in her blog, as some of the blogs she alluded to were very offensive, just subtly worded to be more culturally acceptable. I could just imagine some recent Pulse articles from clearly 'popular' bloggers being written by the current POTUS if he where a UK GP- populist bullshit, and just as ignorant and narrow-minded as Sarah has been accused of.

    Give her a chance to find her style, niche, way to express her ideas. Be honest, but not an abusive uncontrolled troll. After all, successful improvement relies on failure, so don't beat her down so much for what you consider a failure, or she might just stop trying and no-one will ever know what her successes look like.
    I don't write blogs to 'impress' or get 5*, or get lots of pat-on-the-back comments (though a few more comments would go down well guys, even just to tell me it's boring and crap!). I write blogs to share ideas, question a few established orders, stigmas and dogma, to stimulate ideas and hone my thoughts. And I read blogs to broaden my view of what extremes of thought, belief and behaviour really exist to challenge my own bubble.

    So well done Sarah for trying, I hope you learn a few pointers and keep trying. And well done Rebecca for the same reasons, and for standing back with a watchful eye to wider opinions that may not be easy from your vantage point.

    But now you've written this letter I'm not sure they'll bother with the rather mundane, sit-on-the-fence pseudo-intellectual essay I submitted last night- not enough fireworks, more a damp squib!

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