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Leading the flock

I am writing this just after witnessing a moment in history, when for the first time a woman has been elected to chair the BMA GP Committee. And I am deliriously happy about this because it has only taken 109 years.

But as delighted as I am to see Dr Farah Jameel lead the profession, it’s going to be a tough gig. As we approach the festive season, I can’t help comparing the task ahead with those of a long succession of shepherds leading their flock. The sheep in our flock are of a variety of breeds and graze in many different pastures. Some have access to more grass than others, ending up much fatter.

Sheep are at their best in a strong flock, so the first task is to unite us – within the GP Committee itself and across the wider profession. As all shepherds know, it is not possible to please each and every member of the flock but it is important to engage with as many as possible, before making wise and courageous decisions. 

But if the shepherd appears distant and uninterested, the sheep will start to misbehave and wander away. If they go as far as breaking out of their pen, they may even start walking on two legs instead of four, causing much anger and confusion within the flock. 

So, apart from the tasks of listening to, and unifying the profession, what else do we need from our new chair?

The issue that most unites us is workload. I love my job when I am not on call, whereas when I am duty GP, I start the day with IBS and a feeling of dread. Why? Because there is no limit to the number of patient contacts I have; it’s often double that on a normal day. Other clinicians go home when their shift ends but GPs stay until the work is done, which is often at the end of  a gruelling 12-hour day. 

We cannot change this limitless workload without a new contract. A block contract based on list size, as we currently have, has the advantages of predictable income and strategic planning, but where does it fit in a 24/7 digital culture in which customers demand a Rolls Royce service at  Škoda prices?

Surprisingly, Daily Wail readers seem to agree with me. When I make the cardinal error of reading below the line, I see comment after comment demanding that we are paid only for what we do, and this makes me quietly chuckle. The general public has zero concept of how welcome such a system would be for most of us, as we would finally be remunerated properly for everything we are doing. 

I have written about this in the past, but it is worth restating: as a portfolio GP, my practice role is the most emotionally draining, intensive and high-risk element of my work, but the one that offers me the lowest hourly rate. Unless this fundamental flaw is fixed, GPs will continue to withdraw to pastures new.

So, the primary task of our new shepherd after uniting her sheep will be to ensure they have sufficient grass and water to keep working. Otherwise, they will either flee from the flock or drop down dead. 

Dr Shaba Nabi is a GP trainer in Bristol.

Read more Dr Nabi’s blogs here 

READERS' COMMENTS [3]

Patrufini Duffy 8 December, 2021 8:53 pm

And therein lies the problem. The sheep. instead of becoming an eagle, they choose regression towards and donkey. I admire all, but sheep are only herded to be eventually sheared cold, or culled to oblivion. And there are better things to eat than grass and looking down all day. And you know, shepards too can lead you to the cliff face. Where some of you will have to choose, or wake up. Life lessons.

Vinci Ho 9 December, 2021 12:46 pm

I am even more concerned of our youngsters , hence , the lamb.
Will our ‘shepherd’ be Clarice Starling ?
And one day , “You Won’t Wake Up In The Dark Ever Again To That Awful Screaming Of The Lambs.”??😑

Christopher Ho 10 December, 2021 11:27 am

Dear God, where do I start?

“for the first time a woman has been elected to chair the BMA GP Committee. And I am deliriously happy about this because it has only taken 109 years.” – So the gender of the shepherd now matters? When none of the tasks you mentioned involve anything to do with gender at all? And the presumption (much less evidence) that some kind of “patriarchy” kept a woman from being elected chair all this time? Would you have been despondent if a man was elected, I’m curious….

Unite us? There’s no uniting those of us who essentially want a “new contract”, i.e more funding/socialism, and those of us who know from history and evidence that socialism fails everytime. You don’t even see that advocating for itemised funding is 1 step towards a free market system – i.e we get to choose how much work we want to do and how much we want to make, you’re actually on my side on this one. And we all know how (un)likely we are to get that from the govt, too. Of course there’s no recognition of ever increasing NHS funding year on year – https://www.bbc.co.uk/news/health-38887694. Or increasing national debt – https://www.bbc.co.uk/news/business-53859299

Another thing you might not have realised, Shaba, is that the sheep are already leaving the flock, and have been doing so at all levels for a long time – https://www.pulsetoday.co.uk/news/workforce/new-workforce-data-shows-more-gps-leaving-the-profession/.
https://www.theguardian.com/society/2015/aug/23/new-doctors-leave-nhs-for-better-life-abroad.
And that is what happens when the eventual negative effects of a socialized sector kick in. Now I’m sure you wouldn’t advocate for removing that liberty (of choosing where we want to work), wouldn’t you? Wouldn’t you?

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