I’ve been informed on a number of occasions that the best way of achieving quality improvement is to think about stuff that is an irritant. Well, I’ve been increasingly irritated by the preconceived notions of many older GPs about younger GPs.
‘None of them want to be partners,’ they say, or: ‘They just want to clock on and clock off.’
Instead of denigrating our trainees we should turn to them
So I decided to find out what Generation Y really want for their future and organised a conference for Bristol GP trainees. We invited local GP leaders and our keynote speaker was former RCGP president Sir Denis Pereira Gray, who was the highlight of the day. Free from any PowerPoint crutch, he talked for more than an hour about the core values of general practice. He was the perfect panacea for the general pessimism after trainees heard about the triad of crises: funding, workforce and demand.
We were moved and inspired by the narrative of what it meant to be a GP in the world of Sir Denis. Coming from a dynasty of GPs, he told tales of patient poverty from his grandfather’s days, of the dawn of the NHS from his father’s days and of GP empowerment from his own career. He is justifiably passionate about research, but not the type that tells you which ß-blocker to prescribe. It is the type that has been swept under the carpet by policymakers because it is an inconvenient truth hindering their preferred direction of travel.
Sir Denis’s evidence confirms the central role of continuity of care – not only its association with reduced referrals and admissions, but also with increasing patient compliance and reducing mortality. He described it as a ‘wonder drug’, which, if marketed, could earn millions for a drug company, yet somehow it is not approved by the Government. Which other drug with these properties would be denied the chance to get on the market?
He had a profound impact on trainees, who were already cynical about their role in the brave new world of Skype consultations and conducting an ‘orchestra’ of other healthcare professionals. The climax of the day was a Question Time-type panel, with a final vote on trainees’ appetite for GP partnership. To our shock, there was overwhelming support for a partnership role at some stage in their careers – but not in the current climate.
A follow-up survey of trainees confirmed this aspiration. It also asked about priorities for work, and the results will come as a surprise to many. A good team and continuity of care ranked far higher than income and working to rule. Seeing patients face to face in one base, ranked far higher than working from home or patient demographic. And because more than 90% of trainees see general practice as unsustainable within the current funding envelope, over half support alternative funding models.
So there we have it. A new generation of GPs whose values are not too dissimilar to ours. They value worklife balance, but retain the aspirations of continuity, teamwork and high quality of care.
So instead of denigrating our trainees in our most desperate hour we should turn to them. For they are our only hope.
Dr Shaba Nabi is a GP trainer in Bristol