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I worry that ‘micromanaged’ GPs will simply walk away from the NHS



This morning, my contribution to the sum of human happiness was to ask almost every patient if they would mind answering a few questions on their exercise habits, and to categorise them accordingly.

This is, of course, part of the new QOF initiative to see how much harassment you can impose on a hypertensive patient before they get fed up and stop coming to their annual reviews.

From the patients’ perspective, it must be a boon to those who missed paternalism and having value judgments passed on their lifestyle. From our viewpoint, it’s simply another ball that has to be juggled, along with smoking status and the reason the patient actually booked an appointment.

I recently had an email conversation with a friend connected to the Department of Health, in which I tried to explain why these incremental additions to our workload are finally reaching saturation. And the point I keep coming back to is that, if it all goes wrong, the GP is still nominally the one in control.

If the consultation is mismanaged – if you miss something terrible – and someone is hurt or killed as a result, you are as much to blame as you ever were. Never mind that you were distracted by shoehorning half-a-dozen irrelevancies into each consultation. Never mind that you are under constant pressure to reduce your referrals. If something goes wrong, you still carry the can, both morally and legally.

We all accept that this is a job that carries responsibilities. We all feel an obligation to do the most we can for the person in front of us, and a lot of doctors will have suffered sleepless nights when they thought they’d got it wrong. We deal with this responsibility, accepting it as what we were trained for and what we are paid for.

But the other side of this covenant is that we have to be given the freedom to do this difficult, varied, and fascinating job to the best of our ability.

An ever-increasing amount of our time is taken up by things that are not on our patients’ agenda, or on ours. We have to see a rearrangement of priorities. If the threatened mass retirements do take place, remote micromanagement will have played a large part.

If the lights are switched off for general practice, they will have been switched off by remote control.

Dr Nick Ramscar is a GP in Bracknell, Berkshire