It’s heartening to hear the various calls for a solution to the GP workload crisis. However, there still appears to be a lack of any coherent plan.
Could I suggest one?
Bring in a small charge for seeing a GP. Possibly only £5 or £10 might be all that it would take – perhaps more for higher-rate taxpayers. There should be reductions or exemptions for children, pregnant women, certain health conditions, the elderly, and most deprived.
I believe that the BMA and the RCGP no longer accurately represent the opinions of grassroots GPs. Likewise, our LMC representatives seem to belong to a certain ‘type’ of GP. At times, I fear these fervent reps would sooner see their colleagues get into real low points, than contemplate the prospect of offering GPs the chance to vote nationally on bringing in a small consultation fee.
I’ve heard the arguments – the policy would cost more than it would earn; the vast majority of appointments are taken by exempt groups; the disincentive to seeking medical advice would discourage patients from seeking GP input which would lead to delayed diagnoses and greater expense in the long run…
But this isn’t about earning money. It’s about controlling demand. If supermarkets announced tomorrow that bread was free, don’t you think there might be a national shortage?
What I see on the ground is patients who cannot get through to their surgeries, let alone speak to their GP. We must not kid ourselves that the present system is universally providing a satisfactory service. Demand is spiralling, and GP are numbers falling. The system is failing. Wake up and smell the coffee.
And still, in my day-to-day work, so much of what I see is dominated by trivia – minor health anxieties, conditions that would have improved without treatment. Not to mention the over-medicalised who trail around circuits of different hospital departments, from neurology, to rheumatology, to gynaecology…
I don’t blame the patients. The system has encouraged increased dependence over many years. And the phone-first triage system and e-consults perversely teach them that their GP isn’t that busy. But we are. We’re drowning.
Unfortunately, without some cost for seeking medical advice, we’ve communicated that our time is of no value. The public surely don’t consult their accountant, solicitor, or dentist anywhere near as freely as their GP. The status quo may also sadly communicate to our patients that their health isn’t of particular value, either. This isn’t true.
We shouldn’t treat our bodies like a beat up old car that we can take back to the garage at any time and trade in for a new model, at no cost.
As GPs battle to provide a service (of deteriorating quality, with reduced continuity), I cannot help but wonder if the smallest of interventions might make a transformational impact. After supermarkets brought in a 5p charge for single-use plastic bags, the average number of bags bought by customers fell from 140 per year in 2014 to four per year in 2020. A little nudge in one direction can make an enormous difference.
In addition, if we had more time to do our job more thoroughly, I’m certain that our patients would reap significant health benefits. Many could avoid unnecessary hospital admissions, outpatient referrals, or prescriptions. We could redistribute resources towards the most deprived, rather than accepting that poorer areas remain disproportionately under-doctored and under-resourced. A charge need not be a negative step – it could be implemented to focus healthcare where it’s most needed.
We might also find that our job would become more satisfying. Knowing that I had the time to do a proper job, offer palliative care, or personalised holistic support, would be a great encouragement to stick at my career. Being a GP is hard and gruelling. If the pressure from our excessive workload was reduced, GPs would have more mental space to innovate and develop services, practicing creativity and autonomy. We might have time to eat lunch, attend training days, or upskill in special interests. Imagine!
GP practices are collapsing, GPs are retiring in their droves. The endless promises of technological solutions, or remote consultations, won’t make a jot of difference. Fundamentally, the public needs to realise that their health is important, that our time is valuable, and that medical care does have a cost.
Then we might, at last, be able to get back to providing high-quality and accessible medical care. The alternative is that we plod on, lamenting the workload crisis and the inaccessibility of our service, but being too cowardly to tackle this once and for all.
It’s time the profession were given a chance to vote on the issue.
Dr Katie Musgrave is a newly-qualified GP in Devon and quality improvement fellow for the South West