As I was driving my 15-year-old son to his climbing lesson this weekend, I told him I was under pressure to write a blog before Monday and would do it while waiting for him. His response? ‘GPs’ jobs are changing from their intended purpose, and they need to embrace this or they’re going to become obsolete.’
I was floored by this statement and demanded an explanation. He proceeded to talk about artificial intelligence and econsults, and described a future I can only describe as transactional medicine.
Unsurprisingly, I don’t come home every night and talk to my kids about the crisis in general practice. My son has proofread the odd blog, but his all-too realistic insight was truly uncanny. His words came two days after my own reflections, at a GPC England meeting, about the future of general practice.
Despite what others may say, I strongly believe our future depends on the £££ attached to funding us. I reject any notion that funding will not fix the problems associated with workforce and workload. These platitudes are usually spouted by commissioners who don’t wish to stick their hand in their pocket to pay us our market worth. It is disingenuous to ignore the correlation between funding and workforce, and workforce and workload.
If the global sum was tripled overnight, we could double the number of GPs and offer them an hourly rate commensurate with their worth, while ensuring a manageable workload. I could also offer a more family-friendly working day, which was my driver for proposing the contentious ‘Dolly Parton’ LMC motion of a 9 to 5 core contract. The pool of GPs for this is right there under our noses – in CCGs, in appraiser roles and in the private sector, where the hourly rate is far greater than at the emotionally draining coalface.
But you know and I know that this is never going to happen. Not via the global sum, and not via a PCN or federated scheme. The current starvation of funding means that we will continue to haemorrhage GPs and the Government can hide behind the workforce as a cause for the crisis.
So, how does general practice survive under the current funding structure? Simple – as my son implied, it will no longer be general practice as we know it.
I predict that in as little as five years’ time, an NHS GP will never be the first person who sees a patient. The few of us that remain will function at the pinnacle of a pyramid model. Patients will be digitally triaged into large multisite call centres (whose management could be outsourced to other countries) and directed to the clinician who deals with that part of the body. A mental health specialist for the brain, a physiotherapist for the joints, a practice nurse for long-term conditions, a specialist nurse for children or gynaecology, an advanced clinical practitioner for undifferentiated symptoms.
Where will GPs fit into all this? Part of our role will be as consultant to this multidisciplinary primary care team. The other part will be to step into the space that is the increasingly complex area of interface medicine. We will be elevated from community house officers to community registrars and formally take on the mass of work that sits between primary and secondary care.
The question is, will this make general practice more or less attractive? I will let history be the judge.
Dr Shaba Nabi is a GP trainer in Bristol. Read more of her blogs here