I’ll admit I have been Scrooge-like lately, displaying general grouchiness, badwill to all men and women, and a grudging acceptance of the need to see the less fortunate such as the learning disabled or the mentally ill purely because of their QOF/DES potential. But still, I wasn’t expecting a visitation from the Ghost of General Practice Future.
That’s exactly what I’ve had, though. And this vision has been brought into sharp focus by the proposed new Scottish GP contract, which finally gives general practice’s current direction of travel a clear sense of destination. Apparently, we GPs are to become ‘expert medical generalists’.
True, the Scots are taking the high road of what looks like a salaried contract and the English are taking the low one of devolved power. But we’ll end up in the same place, with general agreement that the role of the modern GP is to specialise in complex cases and undifferentiated presentations.
And that’s what the Ghost of Christmas Future showed me. A Monday morning, and me dragging myself out of bed to face my daily multimorbidity clinic. My first patient has T2DM, CCF, AF, COPD, RA and CKD, which I get half an hour to wade through. All the other patients have a similar permutation, giving me a Scrabble hand of abbreviated morbidities which, if it spells anything at all, spells a morning of utter misery.
There’s nothing to discuss because, while all our cases are difficult, none is interesting
At lunchtime, we have our weekly difficult/interesting case discussion. But there’s nothing to discuss because, while all our cases are difficult, none is interesting. Then we troop off to our undifferentiated illness clinics, which entail sifting through whatever our multidisciplinary team has not been able to sort out: the vague, the polysymptomatic, the unexplained and the dissatisfied. It’s like running a pain clinic where the pain is all ours.
Then the ghost shows me a grave.
Now, I do appreciate GPs like me could be accused of constant moaning. And, yes, this might be a salutary lesson in being careful what you wish for. But I guarantee a single day in this new role will have even the most expert of expert medical generalists gagging for the unpredictability, entertainment and spice of our old day job, warts and all.
Besides, this inexorable progress towards a new role makes four whopping assumptions. First, that we really will find pushing water uphill for the rest of our professional lives a sustainable option. Second, that we’ll be able to sell this to potential recruits as a viable career. Third, that the bits hived off to nurses, pharmacists et al can be done safely and cost effectively. And fourth, that our current USP of being able to do multiple things in double-quick time without bankrupting the NHS or killing too many patients is genuinely less valuable than the new USP they are trying to create.
So its a giant leap of faith to which I say, ‘Bah, humbug.’ It’s not what I trained for, not what I’m looking for and not what will make me wake up on Christmas morning a changed man.
And the words on that tombstone the ghost showed me? ‘General practitioner’.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield