I think all GPs are aware of the extra stress on practices and the likely further increases in demand and reductions in income (‘Shocking’ number of GPs seeking pastoral support, say LMCs).
For me, we are trying to utilise a general practice model that was invented before the inception of the NHS to deliver 21st-century care. Many commentators (such as the King’s Fund) are now calling for the cottage industry/corner shop organisational model of general practice to be updated. The RCGP has talked about federation. The Government, I think, is piling on the pressure to enforce structural changes voluntarily – or GPs will have to surrender and succumb to an enforced salaried model, vertical integration or whatever scheme seems politically beneficial at the time.
I always feel we should be in control of our own destiny, yet all I see from GP colleagues is a head-in-the-sand, ‘hope it all goes away or I retire’ attitude. When will we wake up and smell the coffee? There are possible models that maintain continuity of care, improve quality and reduce variation, maintain practice sovereignty, expand and improve services, bring more expertise and care out into the community and yet improve work-life balance and maintain incomes. Successful businesses generally expand and diversify (like Google and Tesco) and, at the end of the day, GP practices are businesses – at least for now. Yet the vast majority of GPs won’t even consider alternative models of working.
I think Pulse should start a campaign that debates innovative solutions to do what I have said above, and at least gets GPs thinking outside the box. I am close to retirement, so none of this will really affect me, but I am getting fed up with the increasingly intense demands from clinical work. Also, I have seen lots of GPs of my age or younger retiring – not because they feel able to financially, but because they can no longer cope with how general practice has become. These are people at the height of their experience and knowledge and they will be sadly missed by their patients, and indeed the NHS.
Dr Malcolm Ridgway, Blackburn