The pandemic has been a time of contemplation for many. Divorced from our usual routines and habits, many have had more time to reflect on where we’re going, and what we’re doing.
I fear that we’ll see an upsurge in GP retirements over the next few years. But that’s another story…
I’d like to take a moment to consider where we would, as a profession, like to see ourselves in ten years (and not just retired).
I wonder if many of you are hoping to be working for larger organisations, perhaps 20 or 30 GPs in some form of federation or super partnership. Acting more like salaried doctors, with a central acute hub, and satellite clinics dotted around your locality. Staff might be expected to move between clinics, as need required.
Administration would be done centrally, as this would surely be more efficient. There would be a large team of other health professionals – nurse practitioners, physios, pharmacists, paramedics, social prescribers and life coaches. The larger organisation might be responsible for out-of-hours, but there would be so many GPs, it would surely not to be too onerous.
Is this what you dream of?
As NHS England has been enthusiastically using coronavirus to accelerate its agenda: video consulting; direct booking of appointments by 111; virtual care home ward rounds; and a temporary removal of bank holidays (when will it be nights and weekends?), I’m left wondering where they want the profession to end up.
If we don’t fight to retain what’s good about our service, are we saying general practice wasn’t worth fighting for?
Do they understand the last bastions of pleasure remaining in general practice? A collegiate working environment; some control over where you work and who with; a degree of continuity of care with patients; meaningful relationships with administrative staff and other colleagues; autonomy over how we manage our booking systems; and appointments. Strip all these things from general practice, and where are we left?
If many of us find ourselves working as NHS GPs, wishing the years away, but not improving the conditions or influencing the direction of travel, we may as well all quit now. If the conditions don’t improve, and we don’t fight to retain what’s good about our service, what are we saying about UK general practice? It wasn’t worth fighting for? Our colleagues didn’t deserve better? Our patients shouldn’t expect a better service?
The PCN DES will come and go. Step by step, the moves are towards a more uniform model of general practice. Working at scale; less autonomy; more Government targets and agendas. But, truly, as GPs do we believe this is good for us, good for our patients?
As the organisations get bigger, do the complex patients receive continuity of care? Do tricky or complex issues get grappled with, or bounced from person to person? Do clinicians have the opportunity to work in their favoured location, with a consistent team? Is duty work manageable, or does the workload spiral out of control? And crucially, is the loss of autonomy a price we are willing to pay?
I’d urge us all to use this period as an opportunity, as a profession, to reflect, take stock, and determine our direction of travel. For if we walk down the path set before us, we may well end up at a destination that none of us wished to arrive at.
Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West