Reflecting on a visit to Australia to see an old friend, Dr Katie Musgrave laments working conditions in UK general practice and wonders why she is still here
If I have written about this once, I have written about it a thousand times. But until things improve, I simply can’t move on…
The working conditions that NHS GPs face are terrible. They continue to worsen, and for many are becoming (or have become) intolerable. This is the underlying source of the crisis in UK general practice. And as more people are driven from the profession, the harder it becomes for those who remain. The perfect vicious circle.
From our unpaid hours, to relentless back to back appointments, to duty days that feel dangerous, to referral pathways so dysfunctional as to make you want to scream, and pathology results and admin that you feel you could drown in. Yes, it’s bad. You know it. I know it. The Government seemingly hasn’t got a clue, and tinkers blindly at the edges… While GPs plan their exits, cut back their hours, and many reach the point of physical and emotional burnout.
The situation we face here was brought into sharp relief on a recent trip to visit my sister in Australia. I met up with a GP friend who works on the west coast, in a beautiful seaside town. She left her NHS post in the UK a few years ago, when she felt her workload was becoming unsustainable. Now she works three days a week in Australia at a bulk-billing practice (providing healthcare to more needy patients rather than private patients).
In Australia, she works 8-4pm two days a week and 7-3pm one day a week. She has a manageable mixture of face to face and phone appointments, only has to process her own admin, can block out appointments whenever she needs to get to a sports day or appointments for her children (her schedule is entirely her choice), and she finishes reliably on time, while not feeling overly stressed. Referrals to the hospital are straightforward, specialists are always happy to give advice over the phone, and she feels she can really make a difference in her role.
For the work she is doing, with a comparable amount of leave as in the UK, she earns the Australian equivalent of £125,000. No partnership duties, extra responsibilities, meetings, or out of hours work. These working conditions allow her to explore developing more surgical skills, and also considering taking on a teaching role. It is easy and affordable to go on courses and upskill (importantly she also has the time and the energy to contemplate this). The lifestyle and weather out there are wonderful and her family is thriving. She’s not coming back.
So, back to the UK. I wonder if tomorrow I will have time for a lunch break (while juggling the dozens of outstanding blood results, prescription enquiries, a possible home visit, and extra appointment requests)? I’ll be doing extremely well if I manage to leave by 6.30pm, by which time I’ll be mentally and physically wiped out. Every year, being a GP here feels like it gets harder, more dissatisfying and unsustainable.
Remind me again why I do this?
Dr Katie Musgrave is a GP in Devon
Bye!
Dear Katie
You’ve asked a good question. Presumably there is an answer, which you are probably best placed to know, otherwise you might have gone already. Personal reasons, family ties in the UK, friends? Maybe there are work reasons too. The NHS pension scheme is probably more generous than in Australia. Rural GP in many parts of Australia is starting to collapse, adding stress to neighbouring practices. As a GP who has grown up and worked in NZ before moving to the UK and having spent 22 years as a GP partner in the UK, I appreciate my job here and feel fortunate. Yes the days are long, but I’m earning a decent income from 6 sessions. I don’t have to worry about billing my patients, worry that they won’t come back because they can’t afford it, or feel pressure to be seeing a certain number of patients to maintain practice income. I feel able to practice evidence-based medicine backed up by local and national guidelines, and feel confident that my colleagues are doing the same, so patients shopping around for an inappropriate prescription are unlikely to get one. I can choose when and whether to refer, rather than being a clerk for referring people who don’t need to see a consultant, but are entitled to under the terms of their insurance. I’m much more able to travel to a greater variety of places (beautiful Devon for example!) without spending 18 hours on a plane. I can swim in the sea, walk in the hills and sit in my garden without worrying about sharks, jellyfish, spiders, snakes and wildfires. The cost of living in the UK, while high, is less than in many parts of Australasia. I can run 5 days a week right through the winter and the summer without getting heatstroke! I’m still in touch with several of my class of ’98. Most of them are doing well but I don’t envy any of them or feel they are “living the dream”. Yes I am very fortunate to be working in a great practice, and this is not the case for many UK GPs, but the grass is always greener,. Very many UK GPs threaten to move to Australia or NZ. Some look into it seriously, but the majority decide to stay here, presumably for sound reasons. Thanks for your article and others, always a good read.
Dear Hamish
Thank you for your thoughtful and grounded response to Dr Katie Musgrave’s article. Your words truly resonated with me.
It’s all too easy, especially in the current climate, to focus on what isn’t working and to assume that the solution lies somewhere else. But as you so rightly implied, the grass is not always greener on the other side — often, all we do by moving is exchange one set of problems for another.
Your reflection reminded me of something I’ve come to realise myself: while it’s important to acknowledge the pressures we face, it’s equally important to take stock of what is working for us — the professional autonomy, the relationships we’ve built, and the broader context in which we practise. Sometimes, we just need that nudge to remember that perspective.
So thank you again for your insight. It struck a chord and helped reinforce a more constructive and hopeful way of thinking about our role in this profession.
Warm regards