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General practice is burning, but I refuse to lose all hope

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Copperfield called hospital consultants ‘white coat mentalists’. I laughed out loud. I read his recent pieces about the implosion of general practice and also Phil Peverley about his recent illness. I respect these guys, their pain is all our pain. Their rage is tangible, but far worse is the hopelessness.

I did general practice because I didn’t fit in the hospitals, not because I was stupid. But I was always branded a ‘failed consultant’ and the patronising tone of every medical SHO still echoes in my head.

I believe there is a solution

Also we had children in my 20s and we needed to settle down. Gender stereotypes are a two-way street. I loved my family and my role was as provider and I have worked full time for over 20 years because I had no choice, life-work balance hadn’t been invented back then.

I found I was a square peg in a square hole in the Glasgow inner city. General practice was full of bright and able doctors. I work countless evenings and overnights too; jumping puddles in the dark, taking piss stained lifts up the tower blocks, to see dying people at 3am with a small bag of largely useless medications. A relentless volume of work and decision making that unless you have experienced it, is beyond comprehension.

There is no situation in medicine that I have not endured, some so traumatic that I actively try to forget. I took daily anxiety induced chest pain as a norm for years. I accepted this all, for general practice is the most important of work and it was my vocation.

Why is general practice in crisis now? It is certainly political. Opening some new hospital was always more headline grabbing than investing in more health visitors. All politicians are more impressed by a bow-tied-oxbridge-academic than some Sunderland or Essex GP (who actually did the job but no one ever asked their opinion).

Successive governments were seduced into more money for hospitals, and worse still, more money for ill-conceived public awareness campaigns that jet propelled public health anxiety. The ‘expert’ always on hand to criticise GPs for a supposed lack of knowledge and delays in referrals. This didn’t just happen once, but relentlessly for decades, constantly undermining the position of GPs. We were forced to refer even when we knew it was bullshit. The hospital system is dysfunctional, inefficient and offers appalling service but gobbles up 90% of all resources. Even if you try, a consultant will never phone you back.

The media did the same, took an isolated case that was emotionally charged to chastise GPs. The GP had no opportunity to respond and balance doesn’t sell newspapers. The Daily Mail was toxic. They presented as fat cats, but seem blind to the private income of consultants. Our supposed protectors, like the Guardian newspaper and the BMA, and others (I’m looking at you GMC) stabbed us in the back by offering their staff private health insurance. The establishment patronises GPs and is too good to see a GP themselves. They actively undermined the ‘my doctor’ GP that most ordinary people greatly valued.

Working GPs are excluded from the selection and training of doctors. The hospital guys and academics only choose people in their own image, so medicine remains the least social diverse profession of all. GPs are relentlessly denigrated by many hospital colleagues. The shrill denials are of course a case of ‘the consultants doth protest too much, methinks’. GPs are tired of this crap. 

Finally, there is a spectacular inability by the establishment to understand that most people are well, not ill. And protecting this wellness is the real role of medicine, not trying to save us from the inevitability of death. GPs are protecting the British population from the international insanity of modern for-profit health care. Look no further than the USA to witness the iatrogenic murdering harm that medicine can do. We have saved the NHS hundreds of billions of pounds, but no one seems to appreciate, acknowledge or even notice our success.

So now many GPs are soon to retire, the last of the chino rationalists. And no amount of new financial corn will keep them working, they can’t stomach anymore scorn. They are off. They are the glue and the system will fall apart. And our medical institutions offer no solutions, for they couldn’t organise a ‘cheese and wine’ in a winery. But I will hold onto the burning match that is general practice in my finger nails as long as I can.  I won’t let hopelessness consume me, for I believe there is a solution

This is the first of a two-part blog from Dr Des Spence as part of our ‘Great GP Debate’ season. Read the second part here. If you would like to write a blog on how you see the future of general practice, then please email the Editor at

Dr Des Spence is a GP in Maryhill, Glasgow, and a tutor at the University of Glasgow