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‘I increasingly feel professionally attacked’

A GP from England wrote a powerful response to their LMC to explain their decision to leave UK general practice and take up a post in Australia. The response is reproduced here with permission. 

Thanks for saying you are sorry I have decided to leave. I wonder if the CCG will express any regret. My wife is a nurse at the local trust. To our astonishment, we realised earlier this year we have given a combined 25 years to the NHS and I’m afraid it’s simply time to move on. The death of a GP colleague earlier this year was a real wake up call for me personally. I was approached by a GP friend in Western Australia and this time I could not think of a reason to say no.

You ask why I have reached this decision. As with all big decisions, there isn’t one reason. On paper, I have everything to which I once aspired at medical school – a quiet, rural dispensing practice, good income, happy patients, colleagues I am friendly with. I suspect my partner thinks I am a bit crazy for walking out on this situation. Of course, he might be right.

However, I have one eye on the horizon. I have long suspected that small corner shop practices like ours are in the crosshairs of NHS England, and this week this seems confirmed by Dr Madan. I simply don’t want to be forced to coalesce and merge with my neighbours to form 50k+ sized blocks. I have 4,000 patients. I know their names, their stories, their problems and often what might be wrong before they even arrive. Continuity is everything. I don’t believe that my patients or indeed ourselves will benefit from bigger supermarket models of primary care. The first federation project, Extended Access is, to me at least, a bizarre way to spend precious GP funding and seems like yet another sop to the worried metropolitan well. Discussing hypertension with a patient I haven’t met before on a Saturday morning, however lucrative, changes the very nature of the role I signed up for in 2008.

Those at the top seemed determined to make colleagues miserable despite a rumbling recruitment crisis and multiple teetering surgeries

I increasingly feel professionally quite attacked. I currently can’t request an MRI for a patient, but know that a less experienced F2 or ESP will do just that when they eventually get to an outpatient appointment. With minimal training or guidance in a complex area, I do my best to dispense fairly and reliably, but get haranguing emails from CCG/NHS England (is there a difference?) telling me that they have identified 0.8% of my list I shouldn’t dispense to under paragraph 99.4 of the regulations and if I don’t sort it within a month I will face ‘immediate contractual action’.

Referrals to many specialities are almost guaranteed to bounce because we have missed off their haematocrit on page 3 of the referral form. We have undue pressure not to refer to speciality x because they are busy. Requests not to prescribe paracetamol but no support should a complaint arise for not doing. We go along to meetings where an entire phalanx of suited data crunchers provide graphs about the number of MSUs we have done in the last quarter, without ever seeming to consider that variation in a population was considered normal when I did statistics. The bureaucratic bar for every LES, DES or additional service gets incrementally higher for less money. The theme; good people, trying their best, treated poorly.

I would have hoped a ‘membership organisation’ like the CCG would be there to advise and speak up for us – indeed this was the GP-led future we were promised, with the death of the PCT. When have I been asked my view on anything of importance? Instead those at the top seemed determined to make as many of their colleagues miserable as possible, despite a rumbling recruitment crisis and multiple teetering surgeries. Even in my short experience, PLT sessions are now quite grim affairs populated by the same few dozen faces who openly admit to treading water until retirement.

I could go on.

I suppose in short, it’s simply taken seven years for me to realise that my naïve idea of general practice does not match the reality. Confronted with that conclusion, I can either hunker down grimly and get on with it, as many have done, or do something about it. I chose the latter.

An anonymous GP bound for Western Australia