We can’t strike, but we can stop treating erectile dysfunction

Dr Katie Musgrave says that GPs should consider rationing non-essential services to highlight their concerns about a profession in crisis

They say that the definition of insanity is to do the same thing over and over, expecting a different outcome. What did we honestly think would come of NHS England’s plans to improve general practice?

Dr Amanda Doyle’s letter outlining the changes being imposed in the 2023/24 GP contract has done absolutely nothing to alleviate the worst fears of the profession. It seems that we are being sold down the river, left increasingly to juggle a thousand balls, while poisoned darts are being catapulted in our direction. NHS England simply do not comprehend the scale of the crisis we face.

But on closer inspection, there are steps we could take, short of strike action, that would publicly highlight our concerns. What about a middle route? A rationing of non-essential services? GPs could draw up a list of services that are not currently safely deliverable. 

The recorded message might go something like this: ‘As a result of years of government mismanagement, your GP surgery is unable to provide the full range of services. If your request is to discuss weight-loss advice, erectile dysfunction, non-cancerous skin problems, or a first appointment to discuss the menopause, we are sorry but we are not currently able to provide a GP appointment. This is an important step we have reluctantly taken to make sure that we can safely meet the most urgent medical needs of our patients. Please visit the front page of our website to read the advice on other options for care during this service disruption. Abuse against our staff will not be tolerated. We are deeply disappointed that our service has had to be limited in this way.’

While taking this action, we would need to outline clear demands. The job of being a GP has become unmanageable, unsustainable and undesirable. We have to fix this. 

The demands could include:

1. Every GP should have a paid session of group educational time each week. A chance to decompress and learn with regional colleagues would improve morale no end.
2. We should demand that ARRS funding be utilised in recruiting extra GPs. Offer every GP a protected session (perhaps just 10-12 appointments) as a sort of ‘extended hours within hours’ in their own practice.
3. Going forward, our appointments need to be capped – we simply cannot absorb endless demand.
4. We should also demand that investment is made in parallel services that lighten the load on us. A government task force is needed, with the sole aim of appropriately reducing and rationalising demand.
5. There must be a recognition that the NHS is on a war footing. GPs need assurance that we will not be held personally liable for medical failings, while practising so far beyond safe limits. 
6. NICE guidance, such as CKS, needs overhauling to acknowledge that we cannot possibly practice medicine in the fashion currently suggested. For example, we need to dispense with fiddling around with vitamin D, most folic acid and B12 deficiencies, and focus on the most crucial lifesaving and life-altering interventions.

It is in NHS England’s gift to reduce pressure on general practice. For example, they could fund and organise a national dedicated menopause service, a universal bladder and bowel service (no more piles or constipation), monitor and moderate demand, resource paid GP time for education and camaraderie, rationalise clinical guidelines, and reassure us about indemnity. These are not unreasonable demands given that UK GPs are currently working in appalling conditions.

But more than any ideas or demands, we have first to find our resolve. It is our patients, including our own families and loved ones, who will be unable to access medical care in their time of need, unless we stand firmly together. The steady decimation of general practice is slowly breaking the wider NHS and leaving millions in need of safe, accessible care. 

A few months of delayed dermatology or menopause advice won’t kill anyone, but the status quo certainly will. What we do matters – and whatever form the NHS takes in the coming decades will require a strong and functioning primary care system.

NHS England do not need to reinvent the wheel when it comes to general practice; they simply need to value, protect and resource us adequately. But GPs need to find some self-respect and fight for better.

One day, our patients will thank us.

Dr Katie Musgrave is a GP in Devon and quality improvement fellow for the South West