The challenges facing general practice are well documented. Increasing levels of multimorbidity, an ageing population and health inequalities are cited in the NHS Five Year Forward View. This is not news, but the message about rising pressures still does not seem to be getting across. Jeremy Hunt’s much-trailed ‘new deal’ for general practice contained neither anything new nor any sort of a deal.
Experience tells us the only effective negotiating tool to bring about real change is a credible threat of mass GP resignation. Holding undated letters of resignation enabled the BMA to negotiate the 2004 GP contract, and the time has now come for a similar move.
This has the potential to persuade the Government to resource general practice adequately and to support us in defining our remit and that of the NHS. While there seems to be a growing belief in some quarters that GPs could be replaced, the NHS would most certainly grind to a halt if it lost us tomorrow.
After all, the health service cannot survive without GPs. Managers calling our bluff is not an option; GPs and their unique role are indispensable in any efficient healthcare system. If we were working outside the NHS, society – whether individuals, co-operatives, insurance companies or government – would have to find ways to reimburse our patients for the use of our services.
While it’s not easy to contemplate turning our backs on a job many of us care so much about, it’s the only way to recharge a profession that’s chronically underprioritised and misunderstood by the Government. As a proportion of GDP, the UK spends less on healthcare than the top 13 OECD countries and, despite the RCGP’s ‘Put Patients First’ campaign, our share of that spend continues to fall, even though 90% of all patient contacts take place in general practice.
While integration makes sense in many ways, there are pitfalls. Super-partnerships and federations are well suited to the current climate, but there is a threat they will accelerate the well-established shift of work from secondary to primary care while allowing social services to raid the cookie jar that is the ring-fenced, but inadequate, NHS budget.
Measures to improve general practice, such as ending media vilification, better targeted health campaigns and improved management of patient expectations will just be a wish list unless we do something radical. That’s why I say we should prepare to abandon ship – now.
Dr John Cosgrove is a GP in Birmingham and an RCGP Council member
At first sight this may seem like a no-brainer – of course we should all resign. Morale is at an all-time low, we are working on less than 7% of the NHS budget and, rather than the promised 5,000 new GPs galloping over the horizon, we will probably have 5,000 fewer by the end of the decade as we retire in droves. Add the disappearance of MPIG and seniority payments, and the fact the number of NHS doctors working as GPs has plummeted to 25%, and things look even worse. Working days of 14 hours have become routine, which is why we’re all permanently exhausted.
Looking at this logically makes the prospect of resignation less rosy, though. Despite the frustrations, to make primary care work we have to be inside the NHS tent talking to ministers, not outside shouting into it.
If we fire our one and only negotiating bullet – the one marked ‘Stuff this’ – from our elephant gun then, yes, there will be a lot of noise, we will briefly feel better and it will shake up the media and politicians. But once the shock and awe has settled, the NHS will still be there, patients with no one to trust but their GP will still need to be seen, long-term care in the community will not have suddenly disappeared and, perhaps most importantly, we will have a divided profession since the one thing we can all probably agree on is that we’ll never get 100% of GPs signing resignation letters.
Within days, public support will plunge from the high level we maintain despite all the setbacks, and the words ‘greedy’ and ‘uncaring’ will plaster the front pages. And that’s without wondering what will happen to our pension, income, premises, staff and cost-rent schemes.
Achieving active change needs mass involvement, certainly, but not mass resignation. We must start with a strong trade union fighting to increase the global sum, to help to stop us drowning in pointless paperwork, and to cut back on futile CQC visits and the bureaucratic burden they impose on us. Working as larger practices may be a way forward, allowing for greater workforce resilience and economies of scale at one end of the spectrum, and better use of premises and resources and increased commissioning influence at the other.
We may all be sorely tempted by the idea of a mass throwing-in of the towel, but ultimately it would be a pyrrhic victory and lead to the break-up of the NHS as we know it.
Dr Roger Henderson is a GP in Shropshire
As debated at Pulse Live in Liverpool – find out more about Pulse Live by clicking here