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The pay squeeze is setting GPs against their staff

Tensions are rising as practices are stretched to breaking point, warns Dr David Bush.

We doctors are pretty resourceful folk, aren't we? We're just wired that way. Give us a coat hanger and a bottle of pop and we'll save a dying man at 23,000 feet. And through years of practice, we GPs are more resourceful than most. We can squeeze a half-hour consultation into a 10-minute slot. Give us the time to do two home visits and we'll manage five. Two hours of paperwork disappears seamlessly into an already full day. Bung us £50 and we'll deal with one person's healthcare needs for a whole year. We are experts at squeezing that little bit extra out of any situation. The toothpaste tube in my bathroom is never quite empty.

We may like to think that we have superhuman powers, but the truth is that in our darkest hours we have developed coping strategies: delegation, teamwork, collaborative working methods. We rely upon highly trained and highly motivated staff, without whom our practices would not be the well-oiled and efficient machines they are. The rewards for our staff have never been impressive. A meagre wage, some job satisfaction and the knowledge that they have survived another day seems to be enough to keep them going.

But now the squeeze is beyond our control. Increasing expenses, lower profits, more work for less money, punitive pension contributions and mushrooming bureaucracy. Oh – and while we're dealing with that, they want us to take time out to restructure and run the NHS. Perhaps in our lunch breaks – if they haven't become a 20th century relic.

So now there is no more squeezing that can be done. We need to make some real decisions. Who do we make redundant? Who do we push until they become unwell through stress? What services shall we cut? How long until we can retire and run screaming from the building?

Festering wounds

I've seen the tangible effects of the squeeze in the readers' comments on Pulse's website. Practice managers slagging off GPs for earning too much, GPs on the defensive in return. Nurses complaining of too much responsibility, receptionists struggling to referee between patient and practice. We are all under strain and this is causing the small wounds within our practices to open and to fester.

Ultimately, the squeeze will be hugely divisive. We will lose good staff and be able to recruit only minimum-wagers. We will not pull together as teams. Our efficiency will dwindle, and with it our viability as small businesses. I'm no financial expert, but I am certain that we will see GP bankruptcies within the next 12 months.

The message to our paymasters is clear. Give us the tools and we will do the job. And we'll do it well.

We always have in the past and we will continue to deliver. We need a good wage and we need the resources to develop our services. More doctors and motivated staff means efficient surgeries, longer consultations, increased productivity and happy punters (or as you call them, ‘voters').

Every survey published repeats what we already know – our customers value, trust and respect their GPs and the services we provide. Great British general practice is still alive and kicking – but only just. Can they really afford to see us fail?

Dr David Bush is a GP in Wolverhampton