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Divided we fall – the impact of the ‘GP fat cat’ myth on NHS solidarity



After yet another week that has seen the newspapers bulging with GP-bashing stories, it’s not the mainstream media articles that hurt. The picture painted of general practice is so comically different from the reality that you quickly stop trying to reconcile the two, and decide they must be describing some other job entirely. It’s numbingly boring, rather than hurtful, to see them rail against the tedious straw man of a golf-playing GP who bins tenners because they’re not worth the bother of carrying.

What is depressing, and deeply damaging, is to think that other doctors might for a moment believe in this grotesque caricature. Speaking to hospital colleagues, it seems that some have bought into the divide and conquer tactics, and think GPs aren’t working hard. If it was ever true, the view of general practice as an easy option is so far out of date as to be a myth. GPs are routinely putting in 12 hours of clinical work a day (often more) with partners fitting practice business in at the beginning or the end. Adding any more hours to this would take an already dangerous workload to critical mass.

As well as the sheer burden of time at the coalface, there is the curious, insidious intensity of general practice workload. We don’t have the dramatic support of a crash trolley, or the high-visibility heroism of a difficult intubation. What we have instead is the logical and methodical balancing of risk, ofteninformed only by our own clinical skills and ability to listen.

I believe that we are hobbled by the fact that, like any quiet skill, this can look easy if you’re not the one doing it. I can only think of one other scenario in medicine where a clinician takes sole, undiluted responsibility for a new patient every ten minutes, and continues to do so for unbroken hours at a stretch. That is the consultant post-take ward round. I wonder if they would consider it a cushy job, doing continuous post-take rounds with no juniors and precious few diagnostics. Especially if every aspect of the patient’s well-beingwas fair game: acute or chronic, across every medical specialty, and stretching deep into non-medical territory.

General practice can of course be hugely rewarding, and great fun. When it’s going well, and you have the time to do your job properly, there’s not much that can beat it. And if you’ll allow me to briefly clamber back onto a favourite hobbyhorse, the times I find most rewarding are when I’m able to catch a spiral of medicalisation at ground level. Transmogrifying a Google Melanoma into a mole, or revealing a slathering Internet Brain Tumour to be a tension headache in Halloween costume – these are the triumphs that we all relish. And sadly, they are all but invisible, because a satisfied, reassured patient never troubles the Emergency Department or the in-patient wards.

I don’t believe that we necessarily have it any harder or easier than other areas of medicine. Every clinician is feeling the heat. But we mustn’t allow the fatal mistake of having wedges driven between us. It’s easy to believe, when you are exhausted and demoralised, that somebody else must be slacking. But hospital colleagues must avoid the trap of blaming GPs for their troubles. As Professor Gerada says, we are one NHS. United, we may yet stand. Divided, we can do nothing but fall.

Dr Nick Ramscar is a GP in Bracknell, Berkshire.