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GPs buried under trusts' workload dump

An exodus of partners will alienate young GPs and locums

Burnout will become rife, continuity of care will suffer and the remaining members of the profession face a rough ride if partners walk away, argues Dr Amy Small

Potentially hundreds of doctors are about to hang up their stethoscopes early due to the ‘perfect storm’ of pension changes, contract imposition, revalidation, and ever increasing workloads, not to mention plummeting salaries. Morale is hitting an all-time low. At 32, I have more years left to work than I’ve lived on the planet and feel that I’m going to have to pick up the pieces. I completely understand why my colleagues feel they need to retire, I have days where I want to join them in it.

After years of setting the bar higher and higher for our profession, the Government has finally managed to chase our most experienced GPs out of the profession with the latest contract imposition. What older partners will leave in their wake is an over-worked and utterly demoralised profession. The fear of senior colleagues exiting ‘en masse’ is that there will be few left behind to take on the partnership work. There are ever increasing numbers of partnerships that are vacant at present. We are also seeing a drop in potential trainees where some places will be left unfilled. This was unheard of when I applied to GP training in 2005.

My peers aren’t stupid. They know that getting into a partnership right now isn’t ideal. Locum work is quite attractive if you want to be a ‘true’ GP. It’s not all rose-tinted, I know: you don’t have the same job security and benefits of longer-term employment, and in England, the pension contributions are going to restrict the number of locums that practices take on or the sorts of locums they take on (more of that later). However, you get to see patients, work out what they need and have time to listen to them without the same pressures to make sure you tick all the QOF boxes. You get to practice medicine - evidence-based medicine at that - and can leave PHQ-9s and their like to someone else.

As alluded to earlier, there will be a new two-tier system of GP locums in England. My newly-retired colleagues who wish to continue working will be very attractive to practices who won’t have to pay their pension contributions. Competition could be potentially quite rife between those that need their pensions paying for and those who are already drawing them. This is going to drive a wedge between sessional doctors and their partner colleagues even deeper.

And where do the patients get left in all this? Ultimately their care is going to be affected. More doctors will be going off sick as burn-out becomes rife, continuity in care will diminish, and the notion of a patient’s ‘own’ doctor won’t exist anymore.

Part-time, full enjoyment

I became a GP for many reasons but mostly, I had visions of being the local GP that would spend 30 years (not more) in a practice, getting to know my patients and their families, being part of the community, and trying to practice good honest medicine. Within three years of becoming a partner I’ve had to cut down to six sessions a week as working full-time was leading to burn-out. I was rushing through clinics, trying to tick boxes, not really listening to my patients and getting through each consultation hoping it would be my last, rarely spending more than seven minutes or so for fear that each patient might actually talk about why they were really there, and that I’d have to address their agenda not just my own.

Now, I don’t mind if I run late. I spend more time, I listen more, and this is because I know that, tomorrow, I’ll have time to wade through my referrals, repeat prescriptions, audits, appraisal, QP referral analysis, QOF reviews, and prescribing initiatives without also seeing 30-plus patients.

For those who say we’re just ‘fat cats’: no matter how much money you would have thrown at me last year, none of it would make up for the relief and enjoyment I now get out of my work. I don’t think I’m alone in having felt this stressed and if GP numbers get critically low we’re all in for a very rough ride.  

Dr Amy Small is a GP partner in Edinburgh and a member of the UKGPC.

Readers' comments (11)

  • Ameer Khan

    Dr Small has hit the nail on the head. Good article. It shows the ground realities of the profession. This profession was very sought after post 2004 contract. I applied in 2006 and had to do jump through 3 hoops before i was offered a place. I was still not given my first choice. There were 50 applicants competing for 3 places!!! I'm sure the reverse trend is on the cards in the years to come.

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