I’ve been trying to analyse what is so unremittingly, depressingly awful about general practice in this day and age. So many times I reach the end of an exhausting surgery, running 50 minutes late, wondering what the point of it all is.
I used to love being a GP. No longer. What on earth is making me so depressed, why do I now hate going to work, and why are my colleagues leaving the profession in droves?
I won’t burden you with the whole thing – You’ve been there. But here are the ‘highlights’:
• A patient had been to A&E with a cough. There was ‘something wrong’ with his chest X-ray. He had been advised to see his GP ‘as soon as possible’. With no access to the result of the X-ray taken the day before, I’m at a loss.
• Another patient has had an operation. He needs a sick note, as you do. The surgeon at our local centre of excellence couldn’t find any in his desk, so advised him to see his GP.
• A lady’s outpatient appointment had been delayed. She phoned the hospital and was told to see her GP if she needed seeing sooner.
• A young man had phoned NHS 111 after having had what was apparently a common cold, but was advised to see his GP ‘to get checked out’, although he had recovered.
• I had referred another lady with intractable chronic pelvic pain to a gynaecologist. He’d had a look, found nowt and discharged her with the advice to ‘see your GP’. As if one more consultation after the first 20-odd would make a difference.
• A couple took their baby to a walk-in centre with a rash. As the baby was less than a year old they refused to see it, telling the parents instead to make an emergency appointment with their GP. The rash had been there for a month.
• A young man with a pain in his back had referred himself to the ‘community physiotherapists’ (who, laughably, do most of their work over the phone. I’m not making that up) and they’d advised him to see his GP to be referred for an MRI scan. Which I don’t have the authority to do.
The gynaecological referral irritates me the most. I refer to specialists when I don’t know what else to do. Writing a letter back to me saying ‘I dunno mate, back to your good self’ is no bloody help at all.
These are all examples of clinical problems bounced back to us by NHS 111, physiotherapy, outpatients, A&E, hospital consultants and emergency care centres. In fact, every single other method of accessing the NHS.
And here’s the reason. The GP contract is unique within the NHS. We get £70-odd quid a year for providing absolutely everything patients ‘need’ (not ‘want’, but they often don’t know the difference).
The cheap option for a system perpetually cutting costs is to send everything back to us – after all, that won’t cost an extra penny – certainly not one extra penny allocated to general practice.
My consultation rate has doubled over 10 years. My income has gone down by 20% in actual terms. General practice has become the dumping ground for everything that no one else can be arsed (or is being paid) to do, and we are expected to absorb it all. This cannot continue. We are at breaking point. Now.
Dr Phil Peverley is a GP in Sunderland. To read more on this subject, click here.
