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What is driving GPs out of the profession?

Dr David Turner

Whenever I talk to non-medical people about my job, they always imagine the worst part about it is blood, gore, suppurating wounds, dead bodies and rectal examinations.

The reality is very different – it’s the red tape, bureaucracy and box-ticking that I loathe. Give me an infected rash to look at any time, over a spreadsheet.

Dealing with disease is what we do. What we’re trained to do and, in some cases, what we’ve always felt our destiny is. No, the very worst bit about the job for most GPs is the endless pointless paperwork.

This fact was highlighted recently in the national press when it became apparent that retired GPs, keen to help with the Covid vaccination programme in some capacity, were being put off by the prospect of having to undertake a sizeable amount of online training. This included fire safety and anti-terrorism modules.

Obviously, it hadn’t occurred to somebody in NHS England that it’s likely that the vast amount of statutory training we’re forced to do may have been one of the reasons they retired in the first place.

One of the few upsides to the Covid pandemic has been relief from CQC inspections and annual appraisals. The mere fact cessation of this enormously time-consuming and mostly valueless work has been lauded by the profession should have sent a clear message to those in power.

However, sadly, I would bet a sizeable sum that as soon as this pandemic is over, we will be back to pre-Covid levels of administrative nonsense.

One of the problems is that private profit-making organisations are making big bucks running online update courses for us to complete our ‘mandatory training’, with so much money involved there will be a lot of pressure to get ‘back to normal’ post-Covid.

What we need is our ‘leaders’ to stand up and point to the fact the suspension of CQC inspections and appraisal has not led to the world ending, and if we want a sufficiently staffed workforce of experienced GPs for the foreseeable future, they need to look carefully at the number of hoops they want us to jump through.

In short, leave us to focus on microbes, not being micromanaged.

Dr David Turner is a GP in west London


Decorum Est 16 February, 2021 1:09 am

And you have summed it so well
That it comes to far more
Than the witnesses
Ever have said. (‘Barristers dream’).

‘What we need is our ‘leaders’ to stand up and point to the fact that the suspension of CQC inspections and appraisal has not led to the world ending’.

John Glasspool 16 February, 2021 8:14 am

“blood, gore, suppurating wounds, dead bodies and rectal examinations.”- They were the GOOD bits!

David Jarvis 16 February, 2021 9:30 am

Anybody who think the blood and gore is a problem are clearly unaware of the success of Dr Pimple-popper.

David Jarvis 16 February, 2021 9:31 am

But how many would be put off by having to reflect on what they learnt from the episode before moving on to the next?

David jenkins 16 February, 2021 10:57 am

well said.
i have applied to be a vaccinator – they want a copy of my o level certificates before i can start training !

never mind i’ve got three medical degrees and have been vaccinating people for over 40 years !
reminds me of a few years ago in bristol.

one day, at about 6am, the computer that controlled all the traffic lights failed for almost six hours !

result ? there were no traffic jams, and no accidents, and everyone got to work on time !

true story.

Thomas Robinson 16 February, 2021 11:01 am

At the beginning of the epidemic,like everyone else,I duly volunteered.
Somehow somewhere despite filling in all the forms on all the sites,i think i was lost.
It would be interesting to know how many volunteered and failed at this first hurdle.

The problem must have been recognised,because, not long ago, I was asked to reapply, using the new shortened version.This runs to 25 pages A4.It repeatedly asks for my bank details though I am not asking for any payment.I believe I have proved who I am and that I am not a threat to state security, yet still I have not actually contributed.
The NHS,undoubtedly employs vast numbers of incredibly qualified staff working incredibly hard,the end result of which is chaos.
Quite simply,the requirement is for administrative excellence,not clinical outcome.There is no-one at the top, or indeed anywhere else,underneath ,with a grip on the situation.Unfortunately,love of the NHS,is a fundamentalist religion,intolerant of alternative views,and blind to reason.

David Church 16 February, 2021 11:06 am

@David : the only reason I do not have the Diploma in Paediatrics was because I could not be bothered to provide a copy of my ‘O’-level English certificate to enable me to enter the exam hall, after having studied for it. As a GP it was not an essential – indeed one of the doctors that finished her intern year while I was there, left to set up as a ‘Specialist in Women and Children’s Health’ immediately on leaving her pre-registration hospital post wihout any such Diploma!

Not Arvind Madan 16 February, 2021 2:31 pm

Its not the red tape itself that is the problem. Its the fact that the red tape seems to have been deliberately set up to make our lives hell.

Try reading the email you receive from NHSE following a spurious complaint sent to them.

David Mummery 16 February, 2021 5:49 pm

Well said David – absolutely right. It reminds me of iconic ‘Morlocks and Eloi ‘ article that was in PULSE a few years ago. The Eloi just want to see patients, do their best and hate bureaucracy. The Morlocks are terrified of seeing patients , love bureaucracy, endless meetings and the power of setting up the bureaucratic hoops for their colleagues to jump through

John Graham Munro 16 February, 2021 8:20 pm


Patrufini Duffy 16 February, 2021 9:44 pm

Yes. Like the hungover bored ‘patient’ that kept prodding their perniuem, and didn’t know what the bony bit was. But needed. a GP explain what a tail bone is. Becoming rapidly, mind-blowingly numb, and hard to keep clarity amongst the warped noise. We should differentiate a true “patient” from a ‘member of public’ who is wanting a trivial explanation of the normal.

A non 17 February, 2021 11:20 am

Yes paperwork and red tape is a problem, but for me its the staggering and persistent levels of ignorance amongst the administrators and managers (including managerial Drs) who run the service, about who their staff are, what they actually do on a daily basis and how they do it that gets me. Many of the diktats from these people are completely stupid. Yes paper work for returning retired GPs has got lots of attention..but in parallel to this heaps and heaps of under employed locums (who don’t need to fill in any paperwork at all!). How can this make any sense, and why are the people running everything so completely unaware? I chose to become salaried rather than a partner because of the idiots who dictate how partners work, i chose to be a locum rather than a salaried GP because the job was shite and I’m currently moving out of clinical practice all together, into research because no-one wants to employ locums anymore. I wont be moving my career in the reverse direction. People are leave clinical practice for more than just paperwork, managerial stupidity is endemic and just as much to blame

David jenkins 17 February, 2021 11:47 am

A non

well said – i, too, am a locum. fully registered with gmc, no complaints in 40 + years, on welsh performers list, on welsh locum list, fully indemnified etc etc etc but can’t vaccinate people with covid vaccine because i can’t produce my o level certificate.

perfectly ok to give all the other vaccines though !

work that one out !!!

John Glasspool 17 February, 2021 3:53 pm

David Jenkins: it’s barmy! I don’t know where my O level certs either, so thanks for the heads up: I shall not apply again. Have you thought of complaining to Dildo Harding? It might give her something useful to do.

Victoria Cleak 18 February, 2021 6:01 pm

Problem is, our ‘ leaders’ aren’t doctors.

Victoria Cleak 18 February, 2021 6:05 pm

@thomas Robinson
That is indeed the slogan. I might get it printed on a Tshirt.
‘NHS, striving for administrative excellence’

Peter Morris 20 February, 2021 10:11 am

Indeed, “CQC inspections and appraisal has not led to the world ending,” As has the invisibility of primary care and lack of pro-activity by GP’s.

Giles Elrlngton 20 February, 2021 10:31 am

Having reached the point where the goal of healthcare intervention is to “protect the NHS”, we should know goal setting has gone very badly wrong.

Our current healthcare politicians should not be revalidated.

Richa Singh 20 February, 2021 11:03 am

well said! I have no idea when are the “Leaders” going to understand the real issues?

terry sullivan 20 February, 2021 12:24 pm

using their brains? noone of intelligence should tolerate nhs and its quangos

Steven Hopkins 20 February, 2021 4:28 pm

Perfect analysis spoilt by adherence to political tribalism at the end. The CQC are not the private sector. They didn’t invent “equality and diversity”, the NHS did that.
I suggest you revisit the 1970s series of Yes Minister.
It will restore your good humor and perhaps enlighten you as to the cause of all our difficulties.

The Parable of A & E. GP requested to attend local A & E for MHA assessment. On duty were one junior doctor, 4 nurses, 1 porter. Also present were 8 receptionists tapping furiously on computers and ignoring cue of patients.

Milos Lukic 20 February, 2021 9:25 pm

I retired while still in my prime after 30 years full time graft without a day off sick because of George Osbourne ( changes to Lifetime and Annual Allowances ) . He did me a huge favour as I’ve had 5 years of relaxing fun while I’m still healthy rather than playing the hero and burning out they dying just for a few extra quid .

Thomas Robinson 21 February, 2021 10:58 am

Steven Hopkins gives excellent advice, though without wishing to be pedantic the series was broadcast in the 80s, apologies.
I believe the specific episode of relevance is Series 2 Episode 1 , freely available on youtube ,please follow Stevens advice.
The British exist in a state of loving tolerant disgruntlement with the NHS, this occasionally flares into semi violent fury when they actually come in contact with it. Specifically when placed on an indefinite waiting list for a clearly serious issue.
Waiting lists will shortly reach 10 million
A GP needs a fast slick well rehearsed dialogue which diverts this violent fury to someone else,anybody else.Therefore directing the patient to this episode saves a great deal of time consuming difficult explaining.
In retirement as I consult over the garden wall with the ramblers,I have found this useful.

Anthony Gould 23 February, 2021 8:27 pm

I agree we are trained to tear patients
We need to have a totally salaried service
Any perceived benefit from being self employed is vastly outweighed by the wasted time filling in forms, meetings of limited value, filing normal pathology, managing staff, shouldering financial risk, backfilling colleague absences etc etc
The returns are not worthwhile and of more concern is the wastes clinical time in a service desperately short of doctors
After 35 years as a GP principal I enjoy half time working as an OOH Locum and doing what I was trained for. I feel much more enthused and happier
I wish I had bailed 8 years ago