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Overwhelming GPs will lead to long-term patient harm



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

READERS' COMMENTS [14]

Tom Blackman 11 December, 2020 5:49 pm

I’m glad someone is saying it Katie. The problem will be that the sign of the engine failing is likely to be complaints directed at us personally rather than ‘the system.’ This demoralises further and adds more workload.

Kristina Kelly 11 December, 2020 7:34 pm

I think you have captured exactly how I feel as a retiring GP particularly your last paragraph- so sad when you don’t have the time to hold someone’s hand when they are dying- Thank you

End Game 11 December, 2020 8:26 pm

An important article Katie, but will anyone of our leaders act on what we all know and are witnessing year upon year? I don’t think so. So the drip drip drip effect of individual early retirements or walking away from our profession will continue.

Cameron Wilson 11 December, 2020 9:05 pm

As a GP who could retire tomorrow I agree with all the above comments and the article! The truth is the current system is unsustainable and has been for years. I have a trainee who has worked in Canada and can’t believe the difference in intensity and demands of working here, the problem is that to initiate the change required cannot be done without some form of co-payment. When you read some of the comments in the usual rags( abetted by NHSE) it’s obvious we are on our own, we desperately need an alternative- BMA you have to cease thinking that tinkering at the edges is progress- our younger colleagues are being hung out to dry ! When a/e correctly gets protected we cannot be left holding the increasingly litigious baby! It’s so sad we have been maneuvered to this position, the truth is that when the public have to pay they will actually appreciate what they get , it seems the case in other countries, I just hope it happens sooner rather than later as this dangerous end game is truelly toxic!

Keith M Laycock 12 December, 2020 4:36 am

Can’t disagree with the commentary and have no idea what, or if, there is a solution. Having qualified in 1968 and having a GP practice until 2016, I wonder if I would have lasted that long if I was qualifying now. Granted, I jumped the NHS for Canada after 7 years in the NHS – certainly different.

Cynically, it’s easier to retire at the NHS – UK average of 58-59 yrs with a life-long pension than it is where no super-annuated pension exists.

Realistically, if anyone feels ground down and ground in by the system, why would anyone stay if there’s a lucrative out?

Scottish GP 12 December, 2020 12:32 pm

Too busy to deliver palliative care, really?

Nick Bradshaw 12 December, 2020 4:51 pm

GP principal and trainer for 20 years. I feel absolutely betrayed by our representatives. The legacy we are leaving for newly qualified doctors is so upsetting. And now the covid ES and lack of support on top of a year of being completely unsupported by CCG and NHSE. I feel angry and sad at the same time. Thank you for sharing. I wish GPs would stand up and say no more. In the long term we are going to do more harm for patients and staff if we fail to act.

Isi Naz 12 December, 2020 7:10 pm

Best article I’ve seen in Pulse- sums things up perfectly….,beautifully written- why is no one listening?
I can no longer provide the care I have struggled to maintain ( killing myself in the process) for my patients. It’s physically impossible and no longer sustainable or safe…. too young to retire but looking for my escape route….

Geoffrey Corbett 13 December, 2020 2:46 pm

Her son was literally begging me for a visit, but I didn’t have time.

I’m sorry but that comment is beyond shameful. The job is awful, a truly dire way to spend your working life but when you put routine dross over patient palliative care then you really don’t get what the job is! The fact that most of the routine work is mind numbing, pointless, never-ending and soul-destroying is no reason to ever leave someone at home suffering.
I trust you simply forgot to mention a colleague was sent out to assist the family.

Cameron Wilson 14 December, 2020 8:55 am

Geoffrey, I feel the use of “beyond shameful ” harsh. The point of the article is to highlight the impossible dilemmas we are being faced with. It might well have been the case that she herself couldn’t attend, it may also have been the case that hospice care had been slashed, district nursing input was on its knees, that there was no available colleague (5k extra Mr Hunt) all contributing to this sorry situation but shamefully the one person who gets it in the neck is the GP.
I am sure instead of using a terminal care example it would just as applicable to mention a teenager threatening suicide, a dodgy d-dimer, a pyrexial infant all which could be on scale of next to nothing or tragic! That’s the reality of the day to day “dross”
Like you I am a paid up member of Old School GP but you have to start asking when your professionalism is being abused and I suspect that we have more than reached that point.
I am sure Katie was using poetic license in this case, but while I have every understanding of the patients perspective we cannot be held personally responsible for systemic failure, that is shameful.

Kevlar Cardie 16 December, 2020 10:31 am

Here’s the thing : no one really gives a s**t about GPs or healthcare workers generally.
As long as they can get 2 weeks per year on the Costa del Scumbag, pay the rent and afford a slab of Stella why should they ?

Tim Lee 17 December, 2020 9:40 am

The really sad thing about this article apart from the obvious insightful accuracy is that this was penned by “a newly qualified GP”…. to have such a bleak landscape at the start of one’s career really demonstrates the state that the profession has got into.

Aris Fragoyannis 18 December, 2020 1:04 am

No change will occur without real doctor-led leadership and unfortunately, the quangos in government and their henchmen in the health department HAVE got some leadership and know exactly what they’re doing. They couldn’t care less how we feel about the situation. Blaming the government isn’t the answer. The socialist SYSTEM which gave birth to this inevitable picture Dr Musgrave has eloquently painted is what needs to be addressed. Of course this is a taboo subject. There are far too many GP socialists in the U.K. unfortunately so I don’t expect much change any time soon. That is the real tragedy.

Concerned GP 19 December, 2020 12:40 pm

I agree with Katie and it is so sad to hear this from a newly qualified GP but this is where we are at. We have such useless leadership; one example
being the countless tweets and messages of congratulations and “what a fantastic job you are doing” etc to people in positions of leadership for hosting a webinar about the covid vaccine roll out on a Sunday afternoon !!! As if that is a huge sacrifice of some sort! I mean they are paid handsomely to do their job right? They can’t even negotiate a decent package for the roll out or for flexibility around the ARRS roles (have a read of the latest guidance which is so inflexible that it’s just not worth it). It’s sickening that we have got to this stage. We seem to have “leaders” who are pandering to their political masters and working their way up to a place in the Lords or some more letters after their name. Meanwhile general practice as we know and love it is being decimated and changed beyond recognition, not to mention the many casualties of all this. We do need to change gears and we need proper, professional and sincere leadership who will stand up to the nonsense and not just go along with the status quo. Unfortunately many of the people who would be best to lead us are fire fighting and so we end up with sub standard candidates.