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Do you want to be a conductor or a musician?



Have you ever had that experience of not seeing a condition for many years and then two patients come along with it within the same week? Or learning a new word and then reading it in the newspaper the next day?

 The ‘audience’ won’t accept inferior performance

Well, I had such an experience recently. First, at an LMC meeting a very nice man came to talk to us about our local primary care ‘strategy’. I use the word loosely because my understanding of strategy is that it should be a detailed plan of how to achieve a goal. This document read more like one of my kids’ letters to Santa asking for a Lego Technic Porsche with no reference to the fact it costs nearly £200.

When asked by the baying crowd how we could achieve our goals with no extra money, the nice chap’s answer was exquisite. GPs would simply need to become ‘conductors’ instead of ‘musicians’. Instead of providing care ourselves, we would become the conductors of other practitioners seeing our patients. No matter that we are trained to play a variety of ‘musical instruments’ to an acceptable standard but not trained to be conductors. No matter that we actually enjoy playing our musical instruments and don’t really want to become a conductor. No matter that we are conducting people who have achieved only a grade 3 on the recorder rather than a grade 8 on the violin. And no matter that we are conducting an orchestra with no personal accident insurance for their instruments.

So you can imagine how surprised I was when I heard the very same words being repeated by the new RCGP chair Dr Helen Stokes-Lampard.

‘We need those bodies, we need more nurses, we need a whole range of allied health professionals, and GPs should be conducting that orchestra to deliver services in innovative ways,’ she said.

Here it was again – I needed to become the conductor of my orchestra in order to deliver patient care.

Now, putting aside my personal feelings about this change of role, I guess I do feel reasonably well equipped for promotion to conductor. After all, I have been playing the guitar, cello, drums and violin for years and I even teach younger musicians to play them.

But how will the conductors of the future learn their trade when they have been deskilled and only played one instrument – the old oboe? How will they conduct those on other instruments when they have never even picked them up, let alone played them? And how will the conductor step in when the pianist is struggling with his or her scales?

The answer is simple. The ‘audience’ won’t accept inferior performance and will demand to know where all their money has gone.

The conductors – the artists formerly known as GPs – will inevitably be blamed for the mess and finally get fed up and go it alone. Amid the resulting dissonance, managers will realise they have made a huge mistake and rue the day they told us to abandon our instruments.

Yet the band plays on.

Dr Shaba Nabi is a GP trainer in Bristol