You might be aware of the boiling frog fable. It states that you can’t put a frog in boiling water, as it would just jump out. But if you turn up the heat gradually, it will not realise it is being boiled alive.
The temptation when applying this (scientifically dubious) fable to general practice is to cast GPs as the frog. But I don’t think this is the case. Over the past decade, with no exaggeration, I have written about GPs proclaiming that the latest Government measure signals the end of general practice hundreds of time.
GPs warned what would happen with austerity, which not only affected the NHS, but also the general health of the population through cuts to housing and welfare among other things. They warned what would happen with the Lansley reforms, or with Hunt implementing seven-day working, and countless other times before and since.
And they have been proved pretty much correct. General practice as we knew it in 2010 is dead. Yes, it was not perfect, but compared to the current state, it was thriving. Now, we have GPs working 13-hour days, unable to meet patient demand, which has led to the wider GP-public relationship being at rock bottom. We have more than 100 practice closures a year, compared with 18 in 2013. We have GPs regularly at the point of burnout. Partnerships were seen as gold dust in 2010, now the NHS is paying £20,000 just to attract new partners.
Sadly, it is the general public who are the frog in this analogy. It seems as though the inability to see GPs face to face on demand is boiling point for patients (why this is the case and whether it should be is another issue entirely). It has taken until now because GPs and practices have done an incredible job in shielding patients from the deteriorating state of general practice. But Covid has brought the problems into sharp focus. The shift to a hybrid model of consultations has been essential – GPs would not have been able to meet demand through the pandemic without it.
But instead of blaming the Government that has spent 11 years turning up the heat, the public is blaming GPs, encouraged by a media that seems happy to do ministers’ bidding. This is pure gaslighting. As I argued in my October column, the salient facts are straightforward and undisputed – the number of appointments has increased at the same time as the number of GPs has decreased. This is a structural problem. Yet the public are being made to believe that the reason they aren’t seeing their GP is because their GP is lazy.
And that is how we have ended up with this shambolic NHS plan that puts all the onus on the GP, with threats if they are unable to achieve the impossible and league tables that will name and shame those practices that face the greatest structural challenges. Not only this, but utilising the classic gaslighting tactic of appearing to offer ‘support’ while actually ramping up the abuse. Such a plan should have faced huge public backlash against the Government for shifting the blame for their own failings onto NHS staff. The fact that it didn’t tells you what a great job the spin machine is doing.
This was such a seismic shift in the world of general practice that, even a week later as I write this, I am still processing what it means and what GPs should go. There are no easy answers. GPs have lost the PR war, and with a media that is very much against them, I can’t see this changing soon. My fear is that GPs will make their own individual decisions, which will likely be leaving the profession in many cases. I, for one, won’t blame them.