Previews of the Year – 2021

DR PETE DEVESON:

As I sit writing my annual prediction column, I find myself imbued with an entirely unfamiliar emotion: hope. Whatever horrors 2021 in general practice may hold, the expectations set by its predecessor were so low that it’s hard to be anything but optimistic as I fantasise about the imminent return of simple pleasures like holidays, gigs, hugging family members and relatively slapdash hand hygiene.

Which is not to say that 2020 was all bad; if you’d told me at the start of the year that NHS England would postpone my appraisal, stand down all the CQC inspectors and mothball the QOF, I’d have bitten your hand off before you could say ‘Monkey’s Paw’. For a brief period in the spring we had a tantalising glimpse of how straightforward general practice could be if all the box-ticking was removed and the great British public decided en masse to self-manage their minor illnesses rather than call the doctor; had it not been for the constant all-pervading fear of death I might have almost enjoyed it.

Of course those heady days of weekly applause for dishing out antibiotics like sweeties while wearing a headset couldn’t last. Demand is back to pre-pandemic levels and now there’s like 100 million jabs to give as well.

So what can we expect this year?

1) The rise of the competitive vaccine selfie. The gyms of Westminster will ring with the sound of pumping iron as our brave leaders strive to get their guns Insta-ready. It would be in very bad taste to photoshop the head of Harold Shipman onto whoever does Matt Hancock’s jab and I would not encourage anyone to do that. 

2) The casual look is here to stay. Dominic Cummings and Boris Johnson have wrought many great harms on our nation, but their sterling efforts to normalise the idea that a middle aged man can rock up to work looking like he awoke hungover in a school dressing-up box and did the best he could under the circumstances leave me almost inclined to forgive them. Sorry Next, you won’t get another penny out of me; from now on, if it ain’t some ill-fitting scrubs sewn together with curtain material by the local League of Friends, I ain’t wearing it.

3) Things getting…back to normal? I can’t wait to stop lying awake worrying about Covid and get back to lying awake worrying about the imminent collapse of general practice. It’s going to be FANTASTIC.

DR KATIE MUSGRAVE:

‘What will 2021 hold?’ you ask,

Another pandemic? The eternal face mask?

‘Surely not, surely not’, you mutter and cry,

‘The vaccine will cure us; we’ll be back flying high!’

We really have had a most challenging year,

Thank heavens so many retirements draw near!

It wasn’t just all the reorganisations,

Then there were all of the confabulations.

‘You’ll get Covid-funding, and bags of workforce;

You’ll be paid for your vaccines; most amply, of course.

Oh dear! Missed the deadline for funds, now, did you?’

Then the workforce, the workforce – they haven’t a clue.

Rest assured, though dear friends, it’s all safely in hand;

Remote consults save us now, please understand.

Then ‘111 first’: do not fear, don’t complain,

You will barely notice the unmanageable strain.

After all, as you find yourselves all on your knees,

Don’t forget to say: ‘Thanks Sir’, ‘Yes Sir’, and ‘More please…’

In 2021, there’ll be more of the same,

More debating the PCN duck (it is lame).

But, we’ll sign up without too much of a mutter,

Then the RCGP weak pronouncements will utter.

Be assured that our numbers will further decline,

And we’ll scratch our heads.  Why?  Now who won’t stand in line?

At least, in this tricky, tumultuous time,

(Please give me a moment, I haven’t a rhyme),

We can rest assured still, that changes are few,

More work, and more jibes, undermining… Oh phew!

Our leaders have mastered their brave navel gaze,

They will issue diktats in a wonderful haze.

Hancock’ll lambast us, why won’t we see more?

As waiting times lengthen: two weeks, three, then four.

‘It’s a national crisis!  Where have GPs gone?’

Didn’t you notice, as the work dump rolled on?

We applied for alternative jobs rather busily,

Some keen to escape now their slice of this misery.

So, another year in general practice will pass,

With frankly the workforce efforts: a farce.

If they still cannot see what is blatantly plain:

That endless demand is too much of a strain,

Then the dumping goes on further, year after year,

And we’ll have little choice but to utter a cheer.

I suspect at the end of the year that’s to come,

We’ll be no better off – I’m afraid I am glum.

The disdain for GPs will be hardly diminished,

Still, hopefully, Covid is finally finished.

But we’re left with the fallout, and mental health mess,

Though it’s not just the patients’…  It’s us too now, yes.

DR KAMAL SIDHU:

This time last year, it would have been a figment of imagination that general practice will look so different within a few months of 2020. We have seen an overnight adoption of technology to aid remote consulting and hence, safe access in a pandemic. We were treated with a pause, albeit temporary, in some of the bureaucratic burdens e.g., appraisals and CQC inspections.

Despite the massive resilience shown by primary care, the times ahead look rather difficult and painful; in fact, very painful.

While we try to find the balance with the use of digital technology and traditional methods of access, we will continue to be vilified by the media who pretend to believe that we are shut. By the time the Covid vaccination is sorted, it will be time to start with the winter vaccination, possibly even next round of the Covid vaccination. Through the seven-day delivery model of vaccine via PCNs, finally, the dreams of the powers of seven day working for routine general practice will be one step closer except those services will have less of GPs and more of everyone else. But apparently, the public does not really need to know that.

With waiting lists for secondary care climb up and with potential ‘new normal’ different way of working, the consultations will be becoming more challenging with pressures to admit, refer and prescribe less. The dumping of work into primary care will continue and add to a toxic atmosphere. In fact, we will likely be vaguely ‘legally’ asked to use the ARRS roles of physiotherapy, pharmacists, social prescriber etc. to help reduce waiting lists for the secondary care. Given the limited influence on massive secondary and community services, commissions will find ways to normalise the transfer of work with or without incentive, further encouraging the notion that if anyone cannot or does not want to do it, send it to general practice. But we must not feel that we are the junior doctors picking up pieces here but instead, we will be considered pragmatic for welcoming it.

The new representatives of practices, for contractual and non PCN DES issues, will be our clinical directors who are already massively overwhelmed. I suspect this is not quite what our negotiators had foreseen and may well generate some reflection.

The mental health of our patients will suffer, and our resources may just be overwhelmed, like many of us. Of course, our psychological health will be tested even further and risks us becoming more transactional to stay sane.

On a positive note, we appear to be en-route to have more GP trainees which may just about help to slow the rate of the overall decline in numbers. I may be being wishful, but a trimmed-down version of appraisal may well become a norm if we just park the new proposals around continuous ongoing patient feedback. There may just be some sensible decision to move to a lighter touch CQC regulation. I am sorry, there is not more to add here.

One thing we have learnt from this year is to not plan and hence, it may well be for the greater good to go with the flow and head into the blissful state of ignorance and do what we can. But, fight we will.

Happy New Year!