I was once asked by an NHS communications person: ‘What is it that would make GPs happy?’ It was a question that stumped me on two levels.
First, I don’t believe anyone does any job to be ‘happy’. I’m unlikely to approach Pulse press deadlines with a Pharrell Williams-esque spring in my step – and I am not responsible for anything approaching the gravity of a hard day of doctoring.
Happiness is a transient, capricious emotion, and a quest for it amid the problems that currently beset general practice would seem particularly futile. Anyone in today’s NHS attempting this would invoke David Cameron’s ‘happiness index’, introduced while implementing the longest period of fiscal austerity since the Second World War.
Second, the question invited such a breadth of palpably obvious answers as to make it meaningless. I could have given a list of things off the top of my head that would make a difference to GP cheer, such as cutting back the QOF, binning revalidation or covering ballooning indemnity costs. But they would have been rather prosaic considering the question posed.
GPs described a job they’d poured their heart into, but had been defeated by
I could have gone for a righteous tone and pointed out happiness had been made more elusive by sentencing the profession to financial ‘penance’ after the 2004 GP contract, or by the cavalier approach to workforce planning that has resulted in the GP shortage now crippling whole towns. Or I could have asked whether happiness was compatible with the small-minded approach of a particular class of NHS manager who has taken general practice for granted over many years and now – while bolting the door on an empty stable – laments ‘if general practice fails, the whole NHS fails’.
I said none of that. As I remember, I mumbled something about morale and CQC tyranny (I’m not at my best when caught off guard) and then clean forgot about it. But the question came back to me as we prepared this investigation, which reveals a growing exodus of unhappy middle-aged GPs that the health service seems powerless to stop.
The data this investigation uncovers are disturbing, but the stories of the recently retired affected me more. I was struck by the description of a job they loved, but were exhausted by; a profession they had poured their heart and energy into, but had been ultimately defeated by. ‘I’ve just run out of steam,’ said one. ‘I was absolutely broken,’ said another.
In this context, looking for happiness is a fool’s errand. Yes, funding, bureaucracy and staffing were all massive issues that in the end propelled these doctors towards retirement, but what was missing in the final analysis was hope. Even a glimmer of light at the end of the tunnel may have been enough to convince them to stay.
The NHS comms person was asking the wrong person. They need to listen to someone in the system, or preferably someone who has recently left it. Listen to how it feels when the health service is making your job harder, sucking the oxygen from your survival tank.
So, belatedly, my answer to the question posed would be: if you really want to know, get out of your office, lined with toughened glass, and spend time with those at the coalface. And then perhaps rephrase your question altogether.
Nigel Praities is editor of Pulse. You can follow him on Twitter @nigelpraities