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At the heart of general practice since 1960

Jesus may have been able to perform miracles, but GPs cannot

Professor Clare Gerada writes

It seems that hardly a day goes by without GPs being in the national press. Whether it’s about us being well placed to address another public health or socially determined disease or a special interest group criticising us for not delivering to the standard that a super-specialist is able to.  

No doubt influenced by politicians, the press tends to oscillate between calling GPs the saviours of the NHS (sorting out the spiralling costs, or dealing with the A&E crises) or its (idle, golf-playing) ruin.

But some journalists have finally sat up and noticed the workforce crisis. Yesterday I was interviewed by a BBC news team about the pressures that GPs are under, and I got the chance to explain to them the stigma attached to GPs with mental health problems, our tendency to work rather than take time off to recover, and the sad lack of confidential mental health services for doctors.

Like so many of you, my main concern for general practice is the health of our workforce, and making sure that we remain sane during these troubling times.

I left my role at NHS London to split my time between being a ‘grassroots’ GP and the Medical Director of the Practitioner Health Programme (www.php.nhs.uk) – a confidential service for health professionals with mental health problems.

Last year, general practitioners made up 41% of all of our patients (although we only make up 25% of medics on the GMC register). Many continue to come with burnout, depression, anxiety or just having had enough.

Pulse has been doing sterling work in identifying the rise in burn out amongst GPs and in highlighting the problems we are facing as a profession.

But knowing this is not enough. General practitioners, as with other doctors, find it difficult to look after themselves and address our own needs. Saying no is not something that we were taught at medical school and we constantly try and fix things for our patients, I am afraid to our own detriment. The reasons why we are so altruistic are deep rooted and over generations have served our patients well. However, now is the time to ‘pull your own oxygen mask down first’ and accept that we cannot save the NHS – or at least if we can, we must save ourselves first.

Against a dwindling budget and falling workforce numbers we are expected to work miracles with almost no resources – the feeding of the five thousand comes to mind.

We are expected to treat more patients, across more sites, over more hours, with a greater degree of complexity, and only a few ‘loaves and fishes’ (read: GPs, nurses and other clinical staff). Jesus may have been able to do it, but we cannot.  

No deal

Recent figures show that the population of Britain has increased by around 500,000, meaning that to serve this new population we will require an additional 278 GPs – just to meet their basic care, in-hours. Even at the best of times, we have fewer GPs per head of population than comparable health services. The ‘inverse care law’ is alive and well in general practice funding.

The ‘new deal’ for general practice delivered in a fanfare by our Secretary of State, is far from a new, or good, deal.  But cracks are appearing around the promises made – for example, Mr Hunt has already backtracked on his promise to train 5,000 new GPs, saying the figure is a maximum rather than a target.

In return for our ‘new deal’, GPs are now expected to work seven days a week – providing routine and emergency care. Of course this is magical thinking as given our inability to even provide five-day-a-week services,how on earth can we stretch to provide it seven days a week? No matter how loud politicians shout or how many feet they stamp, expecting a non-existing workforce to work extra hours is not possible. The maths doesn’t stack up: two times zero is still zero.

Next month PHP is staging a one-day event for burnt-out GPs, which includes presentations, workshops, and reflective sessions on mindfulness, addiction and resilience about how GPs can health one another to care.

In the meantime I leave it to our able medical leaders, Maureen and Chaand, to continue to fight for the best deal for our profession.

Professor Clare Gerada is a GP in south London and medical director of the Practitioner Health Programme.

‘The Wounded Healer’ conference will take place in London on 15 September 2015.

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Readers' comments (30)

  • If the RCGP had agreed to film and have two examiners for the CSA exam then the recruitment crisis would not be so severe. Countless doctors have been binned who would have made good GPs.

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  • 'Professor Clare Gerada is a GP in south London and medical director of the Practitioner Health Programme.' -

    I believe she has a few other roles and interests to declare......

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  • Of course it is relevant to know all the various important roles and involvements as well as business interests of a prominent professional spokesperson, including how many sessions spent wearing different hats. One could argue that total earnings would also seem important to divulge.

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  • @ 11.18 and 11.03

    I think 11.03 your comment might be deleted for that one. However, IT ABSOLUTELY STINKS!!!!!!!!

    An RCGP CSA exam which failed non white UK born and bred GP trainees THREE TIMES more than white UK born. An exam which destroyed the lives of countless IMGs who were ruined. Rather than doing the decent thing, the RCGB hid behind lawyers on a certain person's watch and refused to record the exam and have two examiners (which would have been unconstitutional not to have done in other major western countries). And now the fiasco of what appears to be millions in surplus exam fees off the back of these very same struggling GPs.

    Incredibly, while UK trained GPs are emigrating, Professor Gerada is trying to convince GPs to be salaried and work for organisations like hers. A chiefs and Indians set up (sorry for the pun many IMGs have been scared off for good) which GPs are fleeing from (if they can get out that is).

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  • This comment has been removed by the moderator.

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  • And the GMC (who supports the same false doctrine) gave you money to indoctrinate traumatized and persecuted doctors in another promotional stunt, how low does your self- '

    What are you talking about
    What money has the GMCS given me ?
    Please disclose or remove your post

    What a horrid bunch of posters. Sometimes I can't believe we are in the same profession.

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  • Please visit: http://php.nhs.uk/

    Provided by the Hurley Group on behalf of the Office of London CCGs

    NHS Practitioner Health Programme
    Supporting the Health of Health Professionals

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  • @2.19pm

    - Wow, would love to have see the procurement exercise around this one.

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  • This comment has been moderated.

  • I have visited the above website and according to my understanding Practitioner Health Programme doesn't seem to be a charity but a normal business entity ( please correct me if I am wrong ).

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  • PHP was won through national procurement

    I think some posters need to come to PHP for help

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