Cookie policy notice

By continuing to use this site you agree to our cookies policy below:
Since 26 May 2011, the law now states that cookies on websites can ony be used with your specific consent. Cookies allow us to ensure that you enjoy the best browsing experience.

This site is intended for health professionals only

At the heart of general practice since 1960

The GP contract must reward us for what we actually do best

Why can’t the contract reflect the holistic care GPs provide rather than political agendas, asks Dr Anne Mullin.

The Scottish Government is to be commended on its commitment to general practice that has allowed the Scottish Primary Care system to retain its ethos of universal accessibility for all its citizens. The fact we have our own contract this year suggests greater independence and control in future, which can only benefit patients. It is becoming increasingly apparent that general practice north and south of the border bear no resemblance to each other, and that patients north of the border are the beneficiaries of this philosophical schism.

That said, if the contract is such a winner why then do I feel that I’ve been condemned to another 10 years of hard labour in the GP gulag, where we have a contract that does not reflect our exponential workload? I particularly want to know, what’s in the contract for me and other colleagues working in areas of high deprivation? Our patients become multi-morbid at a younger age and remain hard to reach patients irrespective of the number of letters, leaflets and phone calls encouraging them to attend for numerous physical and psychological screening tests.1 How do I provide the time for patients who do attend not with their single system complaints but rather inconveniently, for the purposes of chronic disease monitoring, regularly blur the edges of their health and social well-being?

The contract does not reflect the qualitative aspects that are core to providing holistic care and that there seems to be an endless unravelling of ‘the mysterious secrets… of the art of general practice’ that can reflect our true workload.2

Furthermore, within the context of swinging health and social care budgetary cuts is an expectation that more can be done in the community, that complex patients can easily be managed at home whilst there is no possibility of shifting money from secondary to primary care.

Resource the holistic approach

General practice is being driven by a public health agenda that has access to our patients through the medium of primary care’s IT systems and regards our patients as a ‘population laboratory’.3 In the rush to categorise, bureaucratise and incentivise the doctor-patient relationship we have ignored the many socio-medical dynamics that don’t suit the traditional bio-medical model. This diminishes our profession and gives us a contract that does not recognise what GPs do, nor values what they are good at – pragmatically working through patients’ multiple problems.

The contract should not be guided by political agendas – telling a patient to exercise more, for example, means little to their health if they cannot first afford their food or heating bills. What of child health and working with vulnerable families? This aspect of GP care has almost been eradicated. And wouldn’t it be great to have an attached social worker resourced to every practice?

There remain major challenges ahead to our contractual obligations if health and social care are to better integrate around children and elderly care services. Integrated care is a political imperative that is being monitored closely, but we will not improve on existing performance unless the contract can be be tailored. Future contracts must reflect changing health needs as much as they can, engage a broad range of GPs in its evolution and stay mindful of the way the NHS is developing.     

Dr Anne Mullin is a GP in Glasgow and a member of the Deep End practice group.

References

1 Mercer, SW, Guthrie B, Furler J, et al. Multimorbidity and the inverse care law in primary care. 2012. BMJ 344, e4152.

2 Heath, I.The mystery of general practice. 1995. London, Nuffield Provincial Hospitals Trust.

3 Shaw, S. E., & Greenhalgh, T. (2008). Best research—for what? Best health—for whom? A critical exploration of primary care research using discourse analysis. Soc Sci Med 66 (12):2506-519.

Readers' comments (5)

  • Well said Dr Mullen,
    I could not have put that better myself. I do think that the "Art" of medicine has been lost in a frenzy of box ticking, and I find myself buried the my head in a computer terminal rather than speaking to my patients.
    Sadly I'm not sure if there is an appetite for either politicians or GPs in less depreived areas to do anything about it

    Unsuitable or offensive? Report this comment

  • Because it's very hard to measure

    Unsuitable or offensive? Report this comment

  • Shaba is correct - Dr Mullin will need to suggest what the metrics are to prove that a holistic programme of care is being carried out - and you cannot dismiss that as being bureacratic form filling - neither can you expect government to give out an open ended contract on the basis that Dr knows best - or perhaps you do

    Unsuitable or offensive? Report this comment

  • unfortunately you cannot measure some apsects of care within the parameters of a biomedical model and evalauting service dynamics with flawed data is not an answer to this challenge

    Unsuitable or offensive? Report this comment

  • I agree with many of the points made my Dr Mullin. However, let us not forget the contribution made to sociey by unpaid carers. What about their health and well being? Carers give up a lot to look after their loved ones including looking after their own needs. Taking care of Carers should be an explicit part of GP Practice including the signposting to carer support groups as well as social services.

    Unsuitable or offensive? Report this comment

Have your say