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This makes my urine boil

This makes my urine boil

GPs’ working lives are being made worse, drip by drip, says Dr David Turner

Have you heard the parable about the GP and the tub of water?

If you throw a GP into a bath of boiling water, they will jump out. If you leave them languishing in a bath full of tepid water and gradually heat it up, they will wither and perish.

No prizes for guessing which scenario applies to us.

Our job and working environment are changing slowly but as determinedly and irreversibly as a glacier slips down its valley.

With the sleight of hand of an experienced magician ‘they’ have gradually forced us to change our practice. Whether this is prescribing drugs we are not familiar with, managing patients who need to be in secondary care or just dealing with the relentless work hospitals dump on, we are all working in a way most of us would have not imagined a few years ago.

Take this week. I have had to admit two patients to hospital, one a patient with suspected heart attack and the other with possible meningitis. At no point in my dealing with these patients did it even occur to me to call an ambulance. Getting paramedics to attend in a sensible time scale has become such an unlikely outcome I have just given up and so have patients. Neither of them even questioned not being transferred to hospital by ambulance while suffering from a potentially life-threatening condition. Not that long ago, calling 999 in both scenarios would have been as normal as breathing out after inspiring.

In the past big changes often happened following violent and sudden events such as wars and revolutions, this is not the case now. Our working lives are changing drip by drip, below the radar. Small and gradual changes, barely perceptible on their own, but added together and we suddenly find we are waist deep in water where previously we had been on terra firma.

Sorry for all the metaphors and analogies in this column, but it is leading somewhere.

As I hope most of you are aware, the Government have imposed a 2.2% uplift in practice incomes this year, against a background of expected costs to rise 6-8%, which amounts to around a 4% reduction in our income. Yes, this is what the Government think we are worth. For offering more appointments in the last 12 months than ever before, with falling numbers of full-time equivalent GPs and increasing numbers of patients per GP, the government think we deserve a pay cut.

I am not unaware that many if not most GPs do not like a fight. Most prefer to bumble along doing what they are good at, seeing patients and taking whatever cash the government choose to throw at them. I appeal to these GPs you cannot do this anymore. If we do not act now, we will see the demise of general practice in a very short time.

For those languishing in their baths soaking up the heat NOW is the time to act. Join the BMA. VOTE in any upcoming referendums regarding industrial action. Encourage your colleagues to do likewise, but please, please get fired up about this, it does matter.

Don’t simmer to death in the pan, but do, to politely paraphrase a vulgarity, let this boil your urine.

Dr David Turner, GP in Hertfordshire 



Please note, only GPs are permitted to add comments to articles

Rob M 18 March, 2024 6:22 pm

When I started in GP land – doing own on call at nights/weekends/etc – we used to be the first call out to see suspected MIs and meningitis . Aspirin / penicillin shot and then take them in own care direct to ED, no ambulance call as we were already on the scene. Plus ca change

Prometheus Unbound 18 March, 2024 8:12 pm

You did not mention the 5.5% pay rise MPs decided to award themselves for the great job they are doing.

Sam Macphie 18 March, 2024 8:40 pm

Why is Mr Hunt ( Chancellor ) looking so smug these days? It’s because he has reduced National Insurance by 2% in this month’s budget (but he borrowed money to do so, Uh-h; and he hoped nobody would notice all the taxes and the stagnant Personal Tax Allowance which is an extra tax trap for anyone whose gross income increases. Plus, he has effectively stolen from State Pensioners like retired doctors, GPs, who do not pay NI and you lose if you have an extra pension (like a NHS pension) as of course the Personal Tax threshold has not increased for years. Bad.
Meanwhile, public services like NHS, GPs and the rest are massively underfunded, and where have HM Gov and Mr Hunt put British money? Squandered atrociously by Jeremy Hunt and his ilk; while he meanwhile, looks so very smug: unbelievable.

Dylan Summers 19 March, 2024 8:15 am

“I am not unaware that many if not most GPs do not like a fight”

David I think you are mischaracterising GPs here. Jamie’s opinion piece on industrial action explains the problem well. Ultimately contractors have only one legal mechanism to respond to a contract they judge disadvantageous, and that is not to sign up to it.

There is no lack of willingness to fight. What there is instead is a collective inability to define what actions would constitute an effective attack.

Paul Burgess 19 March, 2024 10:12 am

Whenever possible industrial sanctions are are discussed appraisals usually get mentioned -ie refuse to have one. But I don’t want to refuse -because I don’t want to get in trouble.
But appraisers are in an ideal situation to go on strike -for, say, a year. I know appraisers believe they are doing good in supporting GPs and therefore indirectly helping patients. But I don’t believe an absence of appraisals for a period of time would harm any patients.
Come on appraisers, it wouldn’t hurt your pocket that much would it?

Philip Brown 19 March, 2024 12:08 pm

I left a good job at the age of 33 in 1993 to read medicine. Retiring early never entered my head. I thought I would be a GP into my late 60’s. Well in 2015 I saw the writing on the wall and resigned from partnership. In the 9 years since it’s only got worse. I work as an associate medical director for an NHS ambulance trust now. This article clearly spells out the state of the UK ambulance service, that I am part of, so in some ways I am no better off. The NHS is so badly broken I don’t think it’s fixable. The politicians have no interest in fixing it, it’s in the “too difficult box” . All politicians only care about the next 5 years. The NHS needs a 30 year recovery plan, with proper funding and a culture of valuing all its staff, not seeing how quick it can burn them out or make them immigrate. For those of you who have a few years to go, I agree with David, get involved, fight for what you went to med school for, to care for patients and do a fulfilling job, before that job is gone forever.

So the bird flew away 19 March, 2024 12:21 pm

I also agree that now is the time for contractors to show they’re willing to take action rather than just lawyerly studying strategy.
I sense the march towards a salaried GP service is inexorable but HMG (or Labour, if they soon get elected) needs to be sent a strong message that the NHS needs an immediate increase in funding and that continuity of care should be restored as the bedrock of primary care.

Not on your Nelly 20 March, 2024 9:44 am

@Paul not doing an appraisal only hurts one person. Yourself. You lose the ability to work both from the performers list and the GMC i.e. you can’t work as a doctor anymore. That has nothing to do with the lack of underfunding and disregard and contempt the profession is being held to by the government. We need to pick our battles and do something (close doors, unsigned resignation letters) something that really hurts and makes people take notice. Putting your license to practice at risk is just sheer not the right battle, unless someone is dumb enough to want to be stuck off. Achieving nothing but lack of livelyhood for yourself.

Just Your Average Joe 21 March, 2024 10:46 pm

The government has imposed contract and pay cut after cut – all because the BMA and GP profession failed to stand firm years ago – and they knew GP’s did not have the stomach to strike. Knowing the gun being held to the government is unloaded – has meant no true contract negotiations have taken place for over a decade.

This can only change if the gun is now loaded – so the BMA NEGOTIATIORS are given a leg to stand on.

Please stop being a Turkey voting for Christmas, please stand up for yourself and the future of General practice.

Vote to fight against this contract imposition and a fair pay deal, and improved working conditions