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A faulty production line

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)

  • I get the impression from this article that although you have cut your sessions and hence presumably your income you now use your unpaid non GP sessional time to do GP work. GP has become a no win situation.

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  • Sadly, if GPs had have cut their hours, allowed more GPs into partnerships, as a result, and received a proper wage, and not the 50% inflated wage increase that they did take, the landscape would look much different today. Job satisfaction, reasonable salary and pension, and no vilification as fat cats. This is the result of short sighted and irreversible greed.

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  • To anonymous above, what do you think is a reasonable wage for GPs?

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  • To Anonymous 09.36 - So what you are saying is work your nadgers off for less pay and be happy. Great.

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  • Anonymous, I don't remember having any choice in the matter & would agree with you if I'd ever had anything remotely approaching a 50% pay rise. The Daily Mail isn't always accurate and certainly won't be drawing public attention to falling salaries.

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  • To anonymous - how much should we get paid per consultation ?

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  • The equivalent of £20 pounds per patient AFTER all the practice overheads have been paid. Sixty pounds for a visit in hours.

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  • It seems likely we are heading back to where we started before the new contract with an annual income of about £70-£80k wte -- just with all the additional work added.

    That projected figure includes all our non NHS work as well.

    In fact, I think this is probably almost official policy 'behind the scenes'.

    Of course we were able to opt out of out of hours.

    Then we just needed to get used to working 12 hr + days instead.

    In many spheres of life, reward for good performance would be considered laudable -- not for GP's apparently.

    Sadly for younger doctors and patients particularly with regard to consequences , the government have sown the seeds and will reap the whirlwind of their punitive approach to negotiations -- demonstrated already in the significant increase in early retirement of senior doctors which has been pointed out in this article and the difficulty thereby maintaining the same level of service.

    It's interesting that consultants seem to have entirely escaped criticism for their increase in pay and there is no attempt to cut that back.

    RIP UK general practice?

    Yes, I will be taking early retirement.

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  • The public have no idea of the instability that is about to be unleashed on the NHS by the attack on primary care. Recruitment to partnerships is plummeting; I watch really bright and dedicated colleagues being daily battered by this tidal wave of beurocracy, the increase in unreasonable aggresive demands from patients spurred on by the Daily Mail in their unrelenting anti-GP campaign.

    Attacked for over-prescribing antibiotics, aggresively complained about by patients when you resist...the same could apply to sick notes, sleeping tablets, home visits.... the list goes on. We have to jump to the demands of the selfish now while the decent patients fall back in priority.

    I suspect the destruction is part of a plan - essentially to corporatise primary care the way dentistry went. However the huge miscalculation is to underestimate the complexity of primary care and this will not work - I'm certain they don't realise this.

    Britain faces the collapse of primary care in many areas starting with the high demand poorer areas. The knock on effects on hospitals will be horrendous and I suspect will cause collapse in many secondary care services. It looks like a whole generation of medical students have been put off primary care.

    A majority of GPs I know are actively planning an exit... this is the end of primary care as we know it. We will only realise too late the reality of how much good work was happening in primary care before the onslaught.

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  • We get £ 2.40 per consultation profit take home pay. Profit per year is £ 48.00 per patient here in NI x 1800 = £ 86400. Consrltations = 6 =. £ 8..00/ consultation.. TAX NI £4.
    Consultations only 60 % workload..= £ 2.40

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