Contrary to the RCGP chair’s view that there is ‘too much negativity’ in general practice, I feel it is imperative to voice our very real, legitimate concerns. Like many, I work in an area of high deprivation and demand and our funding is going down every year. Be it PMS cuts, soaring demands from patients and the system, reduced capacity or more bureaucracy, resource is dwindling in real terms. The system refuses to acknowledge our needs.
Every year we are told to work harder just to receive the same level of funding. Now the practice faces losing even its existing funding if referrals and admissions are not reduced.
Urgent care and out-of-hour services increasingly rely on non-GPs. In a neighbouring area, home visits are now carried out by paramedics. I see patients who refuse to ring services such as NHS 111 because of bad experiences with risk-averse, computer dictated decisions. No one can reassure me that my patients will not come to harm by delaying seeking help as a result. Such harm is not picked up by any ‘key performance indicators’.
Despite worsening recruitment, the very people who cite negativity are refusing to listen and change an examination system that creates fear amongst GP trainees, and continues to result in rising disparity in pass rates based on ethnicity.
I refuse to deceive trainees – I choose to show them the reality of general practice, one of roses and thorns. I choose to discuss the pressures on us over referrals, admissions and prescribing. I believe this adds to their awareness of ethics and community orientation and is vital for their ‘fitness to practice’.
I am being asked to offer seven-day services even though most of my patients do not want to see me on a Sunday. I’m being asked to work in A&E to tell my patients to make an appointment to see me in my surgery. I get emailed to say that my local hospital is under pressure and I should consider not sending my patients in, yet the hospital is never told not to discharge people who are not ready, because I am under pressure.
I refuse to go against my training that I must seek evidence and practice evidence-based medicine. And I refuse to sign up to untested ‘new models of care’ for my patients without them being piloted for their safety and cost-effectiveness.
It is upsetting to be called ‘negative’ because that only diverts focus away from the real issues. It creates a façade and propagates the belief that the system can continue to function safely with the pressures and constraints. It is my ability to highlight the pressures allows me to cope – at least, for now.
And I believe I speak not only for myself, but for my patients too.
Dr Kamal Sidhu is a GP trainer in Blackwall, County Durham