While going through my training years, I moved around various practices, thanks to having my children during the training scheme. I have observed many different shades of GP, and many different styles of surgery. From the hugely dedicated GP in his 50s in a large inner-city practice, who moonlighted as an ambulance first responder, to the GP in a small rural surgery, loved far and wide by his patients. From what I could tell, most of these GPs had derived satisfaction from their work, until fairly recently. When it all got too hard, and too much.
The thing about a machine that is breaking down is that it may creak along for years, displaying some evidence of dysfunction but chugging along all the same. An outsider might comment, ‘looks OK: the old boy is still moving…’ But to an experienced mechanic, the telltale signs of engine failure will be obvious. And one day, something will go, the clutch or the gearbox, and there will be no fixing it. It is fit only for the scrapheap.
The tragic thing about general practice is that we, as GPs, have sat idly by watching the profession get worn down into a state of hopeless desperation. We have all been too burdened by the stresses of managing our own workload, and overseeing our own practices; that we have been led by a union and royal college into ever more dire straits. Who is fighting for us? Who is speaking for us? Who is saying loudly, clearly, and without hesitation, that the workload is so overwhelmingly excessive that no group of professionals could possibly cope with it?
So, we find ourselves with a surge in demand following the recent coronavirus outbreaks, that was entirely predictable. The tsunami of work is here; but the workforce is battered, bruised and on their knees. This year is no doubt going to drive many thousands of GPs to an even earlier retirement. In happy conjunction with this, our health secretary has been gleefully informing us that A&E will nationally switch to a ‘111-first’ model from this December. Only he forgot to publish any data from the pilot areas, to show us where the patients are going to be directed via 111. Never mind ensuring that funding and staff resources follow the patients. Even if only 20% of those triaged by 111 are diverted to their GPs, this will serve to further destroy the remnants of our service. And the practices in the most deprived areas will be hardest hit, despite already being the most under-resourced.
A system wide change on this scale must only be undertaken after careful piloting, and transparent negotiations with all stakeholders. After all, there is little use in directing 20,000 passengers from a sinking cruise ship onto a lifeboat designed to hold 100. The passengers will still die, only in a different vessel. The Royal College of Emergency Medicine may have embraced the ‘111-first’ model, but they have their own sinking cruise ship to think about.
If anyone with any influence might deign to read this blog, I’d urge them to consider some of the suggestions I have made previously. A Covid-pressures support fund, where part time GPs can be offered extra protected sessions in their own surgeries. The extension of the ARRS to cover nurse practitioners or GPs. A suspension of all but the most crucial bureaucracy: we certainly don’t need to be thinking about QOF this winter. Other GPs have suggested multiple other emergency measures.
But the most important thing that everyone must realise is that to overwhelm the GP in this way is to cause real and lasting harm to millions of patients. The other day at work, facing a long list of urgent calls, I had one from an elderly lady suffering in pain, with widespread metastatic cancer. Her son was literally begging me for a visit, but I didn’t have time. This is where we have been taken to by our government, our leaders at NHSE, and the weakness of our union and the RCGP. We have been brought to a place where compassionate GPs have to tell their dying patients that they are too busy to visit. And, frankly, I don’t want to be the person who does that.
Dr Katie Musgrave is a newly-qualified GP in Plymouth and quality improvement fellow for the South West