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Time for GPs to say ‘No, because’ rather than ‘Yes, but’



Following the Brexit vote there has been a discussion among LMCs sparked by an increasing number of requests from patients asking their GP to provide written confirmation stating how long the patient has been a UK resident. The discussions have revolved around charging patients for this and practices wishing to ensure they are not opening themselves up to any legal or other challenges.

To me this encapsulates in a microcosm the brilliance and dare I say shortcomings/short-sightedness of general practice: It shows the utter compassion for the humanity and needs of the patients. And it shows that despite being in crisis, GPs still look to do things that are well over and above their contractual (and in this case arguably their moral) obligations.

The issue of a fee is, in my opinion, a red herring as this is nothing to do with the GP core contract, or even a medical issue in most cases, and GPs and practices simply do not have the capacity to do this; yet the debate continues.

Ten years ago I was involved in another part of public service – the Armed forces – that faced many similar issues to those now faced by general practice. We were being asked to do more and more, in terms of both capacity and complexity and we got to the point where we were breaching Departmental guidelines on the amount of manpower that we needed to achieve the tasks we were being directed to carry out by a fairly significant margin. We wrote to those higher authorities tasking us to explain that continuing this course of action carried very significant risks on many levels and outlined why we thought the tasks should be adjusted to meet the resources. We were effectively told to get on with it.

Less than a year later, the people who had tasked us had commissioned an independent high-level investigation into what had gone wrong; this investigation was inevitable as there had been three serious accidents resulting in eight fatalities in the space of six months. Among a huge number of other findings that came out of this investigation, the most significant in my mind was that it was concluded that in raising our concerns we had been perceived as saying ‘Yes, but…’ when the tasking had increased; had we been more explicit and actually said ‘No, because…’ the outcomes might have been very different.

This is obviously a very, very short precis of a highly complex situation that evolved over a period of time, yet it feels so similar to the situation currently faced by general practice that I wanted to share it more widely.

My question and challenge is how do we empower and support general practice to say ‘No, because’ in a constructive way – and in particular how do we mobilise our patients to be on our side and support our GPs when they do say ‘No, because’? They could be an extremely powerful weapon in this fight to get the wider NHS to really understand just how serious the crisis in general practice is and to do something more meaningful than the GP Forward View to prevent its collapse.