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Are you a proper doctor?



The opening paragraph of a Telegraph article said: ‘A new contract for GPs will see the return of ‘proper family doctors’ responsible for round the clock care and dedicated help for the elderly’. I immediately felt anxious.

Our coalition government feels they need to sort out the crisis affecting A&E departments. GPs are being blamed for this crisis. We are allegedly the reason frail elderly patients are clogging up A&Es and blocking beds on wards. Of course it’s not down to the loss of extended families that care for their elders, complex health needs of an increasingly aged population with insufficient health resources and the lack or inadequacy of care services.

The Health Secretary and the BMA have thrashed out a new GP contract which promises: ‘same day access to doctors via telephone consultations and personalised care plans for the frail and elderly’. This is a coup for the coalition government which feels the 2004 contract agreed by the previous Labour government is the reason we’re in this apparent mess.

Have I missed something here? Don’t all practices up and down the country offer a same day service via telephone consultations? I do distinctly remember a delirious day as the duty doctor last winter where I may have said: ‘Hello my name is Dr Chakrabarti, I’m ringing from Surgery X, how may I help you’ about 70 times. I and many of my colleagues saw some of those callers that day. What else is Mr Hunt hoping we can do?

Knowing and caring for elderly patients is something I do presently, even as a locum. I understand that there is a cohort of the particularly frail and vulnerable (2% apparently) which unfortunately do end up being admitted acutely and subsequently experience morbidity and mortality from a probable unnecessary admission. I don’t mind being involved in co-ordinating their care, but what I’m not so keen on is the round-the-clock care that has been mentioned.

My father experienced the pre-2004 system. He was the friendly, hardworking, single handed family doctor and his patients were able to call him whenever they needed him. He had a pager at home and got paged at all times of the day and night. If it had been a particularly busy night he would come back bleary eyed and tired and then set off to work. It was quite normal for us not to see him much when we were growing up. Then in 2004, I noticed that he was home more and this was down to the new contract. I don’t think that GPs opting out of out-of-hours is the cause of the A&E crisis, but I do feel that the changes in GP-ing in the last 5-10 years has led to a disconnect between patients and doctors. A lot of this has been due to the mountain of bureaucracy which has taken GPs focus away from what they trained to do in the first place. The new GP landscape now has commissioning, CCG work and revalidation to further divert our attention. Also GPs nowadays want a work-life balance and are not prepared to work full time. Plus the workforce is increasingly female-centric. I am currently doing a maternity locum and there is a plethora of them to choose from.

With plans for named doctors, reinstatement of out-of-hours cover, seven-day care and the stresses of commissioning, there is a danger that general practice in the UK could become untenable and lead to a further exodus abroad.

GPs are sure getting a battering in the press, but on ground level, the patients I’ve looked after in the various practices I’ve worked in so far have been very understanding and appreciative about the service all GPs provide. ‘Don’t let the bastards grind you down’, said one elderly patient recently. I smiled and nodded. ‘Hello my name is Dr Chakrabarti, how can I help you…’