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GPs have to start ‘saying no’ to work, says Gerada


GPs have to start ‘saying no’ to work, says Gerada


GPs need to start ‘saying no’ in order to tackle the workload crisis, RCGP president Professor Dame Clare Gerada has said.

Professor Gerada made the comments at Pulse’s flagship conference in London last week, where she was joined by RCGP chair Professor Martin Marshall and former health secretary Jeremy Hunt.

Reflecting on her 30 years in general practice, Professor Gerada told GPs ‘we are victims of our own success’.

She said: ‘GPs in this country do more to a greater degree of complexity and with more patients than any other GP in the world. 

‘And not only do we do everything, but the more we’re asked to do, the more we do.’

However, she added that GPs have to understand the workload crisis ‘is not [their] fault’ and that they ‘cannot innovate [their] way out’ because they have already tried everything.

Professor Gerada said: ‘The only way out of this is if the rest of the system starts to change. The rest of the system has to deliver care that is across transitions – across the primary/secondary care interface – they have to start moving their hospital workforce out into the community, we have to start looking at the funding [and] incentives.

‘When you’re in debates and people are saying to you “you’ve got to work harder and smarter” – no, the rest of the system has to adapt.

‘You have to start saying no. Collectively that is very difficult and our LMCs [and] our GPC have to help us with that.’

She added that GPs need to ‘stop doing other people’s work’, warning that ‘shared care’ is in reality ‘shifted care’.

Commenting on the future of the profession over the next 30 years, Professor Gerada told delegates that while she is in ‘absolutely no doubt that we’re not in a good place at the moment’, the future will see a ‘far better general practice’.

She said: ‘If we really get this right, I think you will be working – dare I say it – in much larger health centres. 

‘They will be available for 50-100,000 populations, so a large multi-system centre that actually has social care, co-located with hospital practitioners. I think you will be delivering continuity, but I think access will be delivered by the whole system, so it won’t just be you.’

She suggested that there will be ‘a much more mature relationship’ between practices and their patients that is ‘a bit like going to a bank’ and that practices will be ‘much more reliant on digital’.

She added: ‘The one thing I think will fundamentally be the same, whether you deliver it online or face to face, will be you as the practitioner delivering that care. I don’t think you’ll be delivering so much care for multi-morbidity [or] chronic disease management, I think those bits will become so complex they will be delivered by a multidisciplinary team. 

‘I don’t think we can predict what patients will be like, but I think the way that you work will be different.’

Professor Gerada also told GPs:

  • There ‘has always been a lack of respect’ for general practice;
  • GPs are ‘all suffering from moral injury because we’re all feeling guilty, angry and fearful’, but they should ‘stop worrying that [they are] failing the system’ because they are ‘the reason the NHS works’;
  • She too works ‘beyond my competence’ and is worried it will ‘bite me further down the track’;
  • She defended the independent contractor and partnership model of general practice, saying it will ‘strengthen us because it will allow us a voice’ but that ‘older’ GPs need to talk about the ‘positives about general practice over a lifetime’;
  • Ten-minute consultations are ‘bonkers’ for all patients on average and consultation length should be ‘determined by the needs of the patient’.

Also speaking at Pulse LIVE, former health secretary Jeremy Hunt said he holds himself ‘completely responsible’ for the failure to fulfil his promise of recruiting 5,000 extra GPs.

RCGP chair Professor Martin Marshall’s keynote address suggested that PCNs may not be the right vehicle for at-scale working in general practice and warned that there is a ‘real threat’ the profession will become like dentistry in the UK.

READERS' COMMENTS [8]

Patrufini Duffy 3 May, 2022 6:11 pm

I look forward to a “Say No” Working Group and Advisory Committee Meeting led by a Professor Tsar of saying No. It can happen, and would add flesh to hearsay advice. And an addition to the RCGP curriculum “How to not get taken for a ride when you qualify”.

Alex Fragoyannis 4 May, 2022 8:36 am

How about starting with ensuring that General Practice is seen as a legally recognised specialty in the UK (as it is in other parts of the world). Specialists seem to have no problem “saying no”. That might actually get you more RCGP subscriptions and respect from GPs rather than being seen as a disconnected, self-serving waste of space.

Robert James Andrew Mackenzie Koefman 4 May, 2022 9:16 am

Absolutely correct so why is everyone still signing up to PCN’s

Lise Hertel 4 May, 2022 10:16 am

GPs are saying NO already, they are leaving in droves and not coming back, working only as lcums to give control over the workload if they have to and retiring early . That’s the only way of saying NO MORE.

Katharine Morrison 4 May, 2022 10:17 am

The RCGP needs to define core work so that all GPs are doing that and can let the rest go.

Cameron Wilson 4 May, 2022 12:48 pm

Sorry Clare, years too late! There is no time left to await change from secondary care,NHSE or HMG, they have no appetite to rock the boat and take responsibility. As above, GP’s are having to adopt an “Every man for himself ” strategy and if either the RCGP or BMA want to represent any significant workforce they need to come up with an alternative option, which has to better than an open ended contract. Without valuing ourselves properly, is it any surprise we don’t get respect!

Patrufini Duffy 4 May, 2022 2:32 pm

Do you remember when all the Apps said No. Sorry, you have Parkinson Disease, are pregnant and too complex. We don’t deal with that, sorry. And all permitted.

Dave Haddock 5 May, 2022 8:09 pm

Start by saying no to the medicalisation of problem gambling.