In a recent speech, I told colleagues that I felt current arrangements for GP training would never release the necessary number of places needed to bolster our workforce. Some remarked afterwards that the problem wisn’t places, so much as the fact that young doctors simply don’t want to become GPs at all.
Unfortunately, I agree with them. They were perfectly right.
Lack of resources, people and increasing demand have led to unmanageable 12-14 hour working days. This has repercussions on our effectiveness, home life and job satisfaction.
It also leads to GPs wanting to retire early and young doctors not wanting to join general practice. It is not only bad for GPs and general practice, it is also bad for patients and the wider NHS. I warned of a fracture – for the first time in my professional career – between GP and patient, with the former being asked to do an unmanageable job while our patients are led to expect ever improving access and a wider range of services.
GPs must stop trying to be heroes. Under current arrangements, GPs who work 14-hour days do so because going home on time feels like shortchanging our patients.
Our profession is being morally blackmailed. Like a person thanked for handing out Christmas gifts another person has bought, the Government has taken the credit for the generosity of UK GPs. Meanwhile the comparative funding of general practice has slumped from 10% to 7.5% over the past five years.
Tackling more demand and more work with fewer people, fewer resources and less finance isn’t sustainable.
The usual solutions – golden hellos and handcuffs – will be wheeled out, but to no avail.
So our urgent task must be to reverse the the erosion of status and confidence in general practice (not to mention our funding and manpower).
Workload cuts
Now, only a major action could address the problem – a Commission on General Practice and the launch of high-level national task groups for reducing bureaucracy, for example. But we must have more hands on deck – particularly recruiting staff such as senior nurses, who previously integrated the care of our housebound elderly with access to health services, social services, voluntary and volunteer services.
Then we must get rid of payments for diagnosing dementia (rather than doing anything about it) and stop writing overdefined care plans (rather than caring). Our mission to care for patients and communities is constantly diluted by workload pressues – from having to lock up your practice stamp for CQC (and in my case, invariably losing the key) and remembering three practice computer passwords, which change each month, to yearly mandatory training on safeguarding children, adults and confidentiality. Little wonder my colleagues lose hope and retire early.
However, the darkest hours come before dawn. I feel NHS England realises at last that things really are desperate. It must know that improved manning and resources are needed, and general practice is key to a sustainable NHS. The monies for GP premises funding and the Transformation Fund are the beginning of that much need cavalry to get general practice back on its feet.
But we need to act, stand up for ourselves and deliver quickly if we are to avoid becoming salaried serfs on the front line of ‘integrated’ organisations led by Foundation Trusts.
Now, more than ever, we need to stand our ground. Turn cynicism and despair in to determination and hope for ourselves and our patients, and end those 14-hour days.
Dr Michael Dixon is the chair of NHS Alliance, a senior adviser to NHS Clinical Commissioners and a GP in Cullompton, Devon.
