As I may have mentioned a million times before, every Unhappy Monday morning I have a psychological technique for successfully levering myself out of bed. It involves cheering myself up by imagining that I’m doing an even more soul-crushing medical job than general practice, such as being an A&E consultant or running the local Pain Clinic.
Now I think I can add another to that list: chair of the GPC. I’m really not sure whether to offer Dr Farah Jameel, our brave new leader, congratulations or commiserations. Pulse has neatly summarised her bulging in-tray and Dr Jameel has already demonstrated a talent for understatement with the acknowledgement that there are, ahem, ‘difficulties’ ahead.
There sure are. And I’d like to add one of my own to her agenda. In ‘resetting’ the BMA’s relationship with the Government, I think her real priority lies not in persuading politicians of the true value of GPs but in convincing them that we are of any value at all.
After all, if you dig beneath the bluster of absurd, tiny funding pots and recycled money, the repeated and repeatedly unfulfilled promises of extra recruits, and the Pavolvian looped auto-bullshit messages of thanks for a brilliant job done, being the bedrock etc etc, then – without even reaching for a tin-foil hat – you reach a rather chilling conclusion. Which is that the Government probably really does believe that the NHS can do away with GPs.
The failure to recruit, by default or design, has meant that patients these days are as likely to see a pharmacist or nurse practitioner as a GP. And plans to progress AI and primary care digitalisation haven’t been shelved, even if Matt Hancock has. All these options are cheaper than GPs and, to anyone who knows sod all about general practice and how it protects the NHS from meltdown, just as satisfactory.
Add to that the current public and media anger over ‘GPs hiding’, which is slowly morphing into, ‘Would we notice if they no longer existed?’ and voila: the NHS may remain free at the point of use but it may soon be free of GPs, too, because hey, who needs them?
There is, of course, an easy and quick way to highlight how hideously wrong this attitude is. It involves reminding the politicians how badly things go pear-shaped when you misguidedly take GPs out of the equation, and it requires just three words: ‘Out, ‘Of’ and ‘Hours’. Dr Jameel is too young for the contractual shenanigans of 2004 to have had a direct impact on her, but doubtless knows her general practice history. And if the Government doesn’t accept her lesson on the value of GPs, they’ll just have to accept the consequences. And at least I’ll be able to stop worrying about that Monday morning feeling.
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield
READERS' COMMENTS [6]
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What if the public were reminded, and politicians that some doctors couldn’t actually care less. Their resilience and bother wears tremendously thin. The charade is over. They don’t care, and it doesn’t bother them. Doors are opening elsewhere. And Gov.UK – Whats the substitute? A footballer? An investment banker? A food picker? An App? A blue collared friend? You’ve started tinkering with the carers, in a perverse and harassing fashion – and you’re in for a yes – quite a faecally loaded future of discontent, riot and aggression. The public will turn against the rich and elite. The dumbest thing the public do not realise, however, is that this Government has got the working class against the working class. Genius plan.
Didn’t understand any of that post-Marxist twaddle, but as an “un-retired”GP, who is now also a patient, perhaps I could add perspective from both sides of the fence?
1. My former Partners are working 12 hour days, and desperate to retire as soon as possible.
2. My former Practice staff tell me that demand, especially at the younger end of the demographic ,is now completely unreasonable.
3. The patients I see when vaccinating them have genuine and identical stories to tell of a Primary and Secondary Care service that is totally dysfunctional on so many levels.
4. The politicians are petrified of trying to reform “Our Wonderful NHS”.
Sadly, no-one knows where to start with the reforms, but perhaps the obvious is: reduce demand.Today’s NICE Guidelines on antidepressants is a good start.We must stop medicalising unhappiness.I have been astounded to see in my Covid vax clinics, a relentless stream of the grossly obese, so perhaps we should also be saying: the best treatment for your diabetes is to go away and lose 5 stone, and it is pointless me monitoring your HbA1c until you do.Ultimately, patients must realise that they have responsibilities as well as rights, and hopefully that may buy us time to chase down the carcinomas.Now where did I leave that Magic Wand….?
What do we do that no-one else can do?
We can carry risk, and treat almost all patients right then and there – directing some of them to the big shiny building where they need urgent stuff done.
But ever since David Cameron announced his Zero Risk strategy, no-one is willing to carry any risk. – at all.
At which point all patients might as well turn up at the big shiny building, where they can have the bejesus tested out of them.
Only slight problem, this would, I imagine – looking at the US Healthcare system – approximately double the cost of running the NHS (and worsen outcomes). But hey, if that’s what people want then, yes, you don’t need GPs at all. We just get in the way of patient ‘wants’ with our pesky desire to try and work out patient needs. How very tiresome.
Too late now. I think GPs will end up being Private (as most of those prepared to pay seem to get the nuance of what a good GP can do, presumably because they are quite switched on) and let the Daily Mail readers go to a franchised Fast-Primary-Care-Drop-in-theme-park where they can have lots of access and probably lots of return visits to discuss the slightly raised LFTs/ PSA / borderline ECG over and over and over and track their own progress on a sexy App. They’re welcome. If NICE continues to tell everyone when to fart, the Omni-Practitioner won’t need to use any judgement at all. George Orwell, where are you?
The good news is that the more dysfunctional the patient experience of NHS GP gets, the more opportunity for escaping the ghastly NHS into Private GP.
ps. Other models of healthcare exist beyond UK NHS and the USA. But if you have a stroke, MI or develop cancer, your chances of survival are significantly better in the USA than the UK.