To say it’s been a challenging time for general practice would be an understatement. I am writing this two days after that NHSE ‘support package’ dropped into my inbox. Once the immediate shock and tears subsided, my most prominent emotions were confusion and despair.
It is likely my practice will fall in the bottom 20% of many of the performance targets, which include GP appointment numbers, attendance at A&E and NHS 111 callouts. Of course, NHSE has no desire to examine the evidence that suggests A&E attendance is associated with deprivation and proximity to the emergency department. In England, we have been living in an evidence-free zone since before the start of the pandemic.
Many will think of this as a watershed for general practice, but I see it as a Sliding Doors moment. In the first scenario, we miss the train and our subservience to NHSE continues, until we sleepwalk into a salaried service resulting from partnership resignations. In the second, we stand together on that train, side by side, and we say ENOUGH. We carve out our destiny and we continue riding the train for many years to come.
The problem is we seem to have no clear idea where we want this train to go or how to get there. Do we have a strategy, a vision, or a mission statement for our profession? Do we have any notion of how we wish to practise in the years to come, or are we allowing ourselves to be mis-sold the illusion of the expert medical generalist because we believe it’s the only option?
I have been writing for many years now about the risks of being a conductor instead of a musician – of constantly working at the top of your license supervising multiple allied healthcare professionals who act as gatekeepers for the gatekeepers. For me, general practice is about treating a patient’s simple ear and throat infection while she is a student. It’s about being there when she plucks up the courage to attend for that lump she has noticed. It’s about helping her navigate her breast cancer journey and then seeing her with her kids once she has recovered. I no longer want to be the voice at the end of the phone, or the message on the screen, dishing out instructions to the myriad of others looking after my patients.
I know there will be many who will deride the aspiration of continuity from a GP who doesn’t work every day. These will be the same people who insist that working three 12-hour days a week in general practice is ‘part time’.
Continuity is our USP, and I believe we can still achieve it without being present in the practice for every single core hour.
Despite being dual qualified in medicine and general practice, I don’t wish to be an expert medical generalist – aka risk sink. I joined general practice for the variety it brings, and I want to be a bog-standard generalist. I do, however, believe it’s unsafe to force GPs to practise conveyer-belt medicine and, for my patients’ sake as well as mine, want my contacts to be capped at 30 per day.
Is this really too much to ask?
Dr Shaba Nabi is a GP trainer in Bristol