As part of the Pulse in Print series looking at the current state of the profession, columnist Dr David Turner says that GPs are continuing to display courage and determination
We may be battered and bruised like bare-knuckle fighters, but we’re still fighting the attempts of the multiheaded beast (CQC, NHSE, DOH, GMC, etc) to bully, cash starve, bad mouth, blackmail and generally browbeat us. We cannot let this malignant hydra win.
It hasn’t always been like this. Until quite recently, it was not uncommon for patients to talk about ‘my GP’. The singlehanded doctor, working from a converted house, with a receptionist and possibly a nurse, may seem like a tale from Dr Finlay’s Casebook to young doctors, but it was a real thing: I worked as a locum in many such surgeries, where dust-covered notes competed for desk space with patient thank-you cards.
Now, the norm is increasingly a polyclinic, where patients have no idea who anyone is and continuity of care is about as common as sensible ideas from NHSE. Sadly, bigger, more anonymous practices look set to stay, run by a few GP partners who are more like accountants than doctors. A world away from Dr Finlay.
But we can get back to a model that helps patients and makes general practice a better place to work.
Conservatives go on about getting ‘back to basics’ so let’s do that. Continuity is the single most important way to improve outcomes and reduce mortality. So, let’s value this in monetary terms. Giving meaningful sums to those that prove they offer good continuity will begin to favour small and medium-sized practices again – which are the sort most patients prefer.
GPs need to be explicit with patients about how many appointments we can offer and how many we lose to box-ticking and admin. All the time we spend on appraisal, revalidation and CCQ inspections should be calculated and displayed in waiting areas and on practice websites in terms of lost appointments. This would show patients how these mostly pointless activities take time away from them.
We should encourage patients to write to their MP if they are not happy about this. It is about time we stopped being doormats.
Despite all the problems, we have the best job in the world. I, for one, would not do anything else.
Dr David Turner, GP in Hertfordshire
READERS' COMMENTS [3]
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I’d also stop triage and remote consulting. All F2F. The single most efficient and best quality event in the NHS is a doc and a patient in the same room for as long as it takes to make a decent plan. And no more “one problem appts” – like triage, a shameful economy we’ve been duped into. One prob appts are a disgrace and an insult to the patient. As a profession we have sold our souls.
Alas, it’s too late to go back to ye goode ol’ dayes.
– devolving polyclinics back to multiple small practices would be ruinously expensive.
-the introduction of PCNs clearly indicates that our masters still favour the “larger scale” approach they’ve championed for decades.
– younger GPs simply don’t want lifelong partnerships any more , and who can blame them.
– demand has been stoked up so high you can’t put the genie back in the bottle, so ending triage would overrun even the most efficient appointment system.
-we’ve been begging for an end to CQC/appraisal nonsense for years, but it’s clear those in charge are hell bent on keeping them.
In the absence of deserting doctors, some practices have perished, some clubbed together, whilst others have adapted to the Consultant GP model using ARRS as second prize. But there’s no going back, those misty-eyed halcyon days of Dr Finlay are long buried in the fading memories of the 20th century, the uncaring boot of the Brave New World of modern primary care has crushed those dreams.
I’m gonna avoid offensive language here but you may read between the lines if you please. Qualified 1990. 33 years in GP. There’s nothing wrong with the GP model that a bit more funding and a bit less micromanaging would not solve. But I agree, it’s pissing in the wind. The jewel in the crown of the NHS is being systematically dismantled. It will cost the taxpayer twice as much and lead to worse care. Why don’t they listen to people with experience? They hate us. I hate them back with interest. I truly hope they are held to account for what they’ve done.