Columnist Dr Burnt Out takes a satirical look at what 2024 could have in store for general practice
January
The junior doctor strikes start and GPs receive a letter from NHS England saying that they should open their surgeries 24 hours a day during this period; there will be no extra payment as it will come under an emergency new implementation of a ‘goodwill clause’ that will become a part of the GP contract.
Wes Streeting meets up with Elon Musk, Jeff Bezos and Bill Gates to get their views on the future of the NHS; it is revealed by Downing Street that Rishi Sunak has an AI ‘friend-bot’ who he consults with daily.
Meanwhile, the number of unemployed sessional GPs in England alone has reached an estimated 5,000.
February
The BMA GPC sends a ballot about possible IA; there is confusion when the result is deliberately leaked to both the mainstream and medical media by a BMA GPC media mole before any official BMA statement.
There are now 8,000 unemployed GPs looking for work, but all jobs have gone to PAs and ‘advanced frontline practitioners’, so many GPs are considering finding work abroad.
However, there is talk about expanding the ARRS with a new ‘first contact primary care frontline associate medical practitioners’ (FCPCFAMP) role, which will come into effect in April 2024. All remaining GPs in the health service nickname it the ‘I’m f**cked’ role.
In other news, Matt Hancock announces his return to frontline politics. In the next election, he will stand as the Monster Raving Looney Party Candidate for Chester North.
March
Mr Streeting says Labour is looking into AI GP and PA avatars (similar to those performing in the ABBA Voyage concert) who will start seeing patients; the AI GP avatars will still have to supervise the PA avatars, and the PA avatars still won’t be able to prescribe any medication.
At a press conference demonstration of the avatars, Mr Streeting explains that there are huge advantages to them: they do not age, and the Government does not have to pay them any pension.
The Daily Mail celebrates this development and says it is almost tempted to support Labour in the upcoming general election. But now that Nigel Farage and Jacob Rees-Mogg have launched a joint ‘double dream ticket’ for the Conservatives, the paper will support them instead.
April
There is chaos in Northern Ireland as a large group of GPs on their lunchbreaks make a co-ordinated storm on Stormont, break into the main chamber and tell the MPs to ‘get off their f**king backsides’ and start doing some proper work. The GPs then go back to their surgeries to do their surgeries and on-calls.
May
At the UK LMCs conference at the Celtic Manor Resort, there is widespread disruption as a maverick group of renegade Welsh GPs called ‘GPs of Glendower’ climb on stage and unfurl large banners in the main auditorium and demand that the Senedd has an emergency session about general practice. The police is eventually called and the whole session is live-streamed by BBC Wales News.
The RCGP calls for all its members not to fly anywhere on holidays due to the climate emergency.
June
There is a general election and it is a hung parliament. Mr Farage and Mr Rees-Mogg try to strike a deal with the Monster Raving Looney Party, which has the balance of power. But new MP Mr Hancock decides to join forces with Labour on the condition that he is made foreign secretary. Sir Keir has no hesitation in agreeing, and the new coalition is formed.
Around 90% of all primary care contact is now not with GPs, as thousands have emigrated. General practice is now regarded as a purely supervisory non-clinical specialty, which mainly involves a lot of finance with hours spent looking at spreadsheets over coffee with the practice manager.
July
Mr Streeting announces the new ‘Bevan Centres’ for primary care, and all the primary care estates will be merged and upgraded in the development of these centres.
Sir Keir opens the first Bevan Centre in Tredegar, South Wales, and does some magnificent rousing oratory standing on a hilltop speaking to about 15 assembled constituents and journalists in the drizzle. The launch is a PR failure, and the Labour party launches an investigation.
The RCGP states that as there aren’t many GPs left, membership is now open to anyone working in primary care. The organisation will be rebranded as the The Royal College of Primary Care (RCPC).
August
GPs announce three days of industrial action.
A patient walks into an empty waiting room in a large medical centre in London and stages a ‘sit-in’ until the GPs come back to work. The patient is gently informed by the receptionists and police that the strike was over two weeks previously and it is now ‘business as usual’ in general practice.
September
Rents and utility bills soar for practices, and many GP partnerships face huge unlimited personal and joint liabilities.
It is clear that a GP partnership bailout is needed, and the BMA GPC starts a series of meetings with the treasury and Mr Streeting. Meanwhile, Mr Hancock also demands to be involved and threatens to withdraw Monster Raving Looney support if he is not.
October
A multi-billion pound GP partnership bailout is agreed: all the remaining GP partnerships are dissolved, and a new ‘national GP contract’ is agreed with GPs.
The terms and conditions are well negotiated by the GPC, and similar terms and conditions are also agreed for consultants. It is hailed by the BMA and Labour as a ‘new deal’ for general practice.
Thousands of trained GPs who emigrated return, and all the unemployed locum GP workforce sign up to this new contract and start working at the Bevan Centres. It has a ‘PA’ model with protected time for CPD.
November
The frontline GP workforce is rapidly building up, and thousands of GPs are back in work (that is, seeing patients and not in finance meetings). The BMA GPC congratulates itself on ‘saving general practice’ and co-ordinating the bailout. The GPs of Glendower disband but still meet up in the local pub.
Mr Hancock is promoted to Deputy Prime Minister.
December
The RCPC states that due to the likely change in the law about assisted dying, there will be a profession-wide consultation regarding how it should be implemented when the law changes. They hope this will stop the flow of people travelling to the Isle of Man and Jersey. Meanwhile, Scottish GPs declare that they will not see any patients travelling to Scotland for euthanasia.
Finally, Sir Keir and Mr Streeting hail the reborn GP service ‘fit for the future’ and claim they have delivered on their promises to ‘bring back your local GP’ via a country-wide advertising campaign.
The future of general practice is saved… but for how long ?
Dr Burnt Out is a GP locum in London
