Our core is killing us. I don’t mean our abdominal muscles when we have been planking too long, but our core contract. Every time I try to analyse the issues in our job, it all comes back to the fundamental issue of our core.
Let’s start with core hours. Why are these arbitrarily set from 08.00 to 18.30 for routine care? I can’t go to my dentist or bank after 17.30 so why should I still be accepting calls an hour later? Speak to any duty GP and they will tell you of the huge sense of relief when the phones are finally switched over at half-past six and the floodgates are shut until the next morning.
Now we are delivering extended hours in the evening and at weekends for the working population, there is even less reason to have a core contract stipulating 10.5 hours a day. Its origins may lie in the negotiation of the 2004 contract when we relinquished our responsibility for out-of-hours care, but that is now nearly 20 years ago. Gone are the days when there is a spouse at home to look after the children, and it is almost impossible for younger parents to secure wraparound childcare for 12 hours a day.
Then there is the unlimited demand without any cap. We have normalised this to the extent that we think there is something wrong with any GP who is unable to subsume another 20 calls in addition to their full day’s workload of 30 to 35 patient contacts. Having recently watched the BBC’s adaptation of Adam Kay’s memoir This Is Going To Hurt, I’m reminded of the normalisation of our 100-hour weeks when we were juniors. We will look back one day and marvel at how we saw this number of patients in general practice and accepted it without objection.
Our simmering complaints are being translated into RLE – retirement, locum or emigration. We are not fighting back as a profession, we are fighting for ourselves as individuals, and it’s resulting in the slow and painful death of general practice. And who can blame us? When you are close to burnout, it’s far easier to change yourself than change the entire system.
If we have any chance of saving general practice, it is by moving away from an outdated all-you-can-eat buffet and having workload caps, like all other healthcare professionals. It seems to be hardwired into GP partners that the independent contractor status is synonymous with servicing any number of patients within core hours, regardless of their safety or our sanity. We have internalised an activity-based contract, as opposed to a time-based contract, with the delusion we are small businesses required to fulfil our core contract. The current system is setting us up for failure as we are caught between a rock and a hard place. If I am emotionally drained and exhausted after juggling 40 contacts in an 11-hour day, what do I do with the 41st call? Do I risk a contractual breach by turning them away, or do I risk my indemnity by consulting when I do not feel fit to practise? Every single day, GPs are faced with this dilemma and just carry on, praying that nothing adverse will happen.
And every so often, something adverse does happen. And no one cares that the patient was your 41st call. No one cares about your flawed contract. No one cares you were three GPs down with Covid. All that matters is the patient in front of you and the care you delivered.
We are being judged for perfection within an imperfect system, and I’m not sure how much longer I can carry on colluding with this.
Dr Shaba Nabi is a GP trainer in Bristol.
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