General practice in the UK has a dilemma, and I feel that I could be part of the problem.
One issue that major political parties concentrated on rior to the election was the number of GPs working in the NHS and how they wanted to increase this. What they were really talking about is the number of appointments available to the general public. Despite the fact that no minimum number of appointments per week per head of practice population exists, the implication is that more GP sessions are needed to meet patient demand.
The demand of patients may not, in fact, be entirely reasonable all the time, or that there are factors that influence demand such as politicians, the media and the need for doctors to meet health-related targets. But putting that aside for now, it’s clear that what the politicians haven’t commented on is how many sessions they expect to get from their thousands of new GPs. Recently a very experienced GP told me that she thought that six sessions per week was the ‘new full-time’ and that anything more was unsustainable in the current workload and climate.
What if part of the issue is that workload pressures mean that GPs actually work fewer hours, creating a shortage of GP appointments, even if there are lots of GPs?
I work six sessions a week. It suits me. I don’t actually need to work anymore than that in a financial sense and, among other things, I find it keeps me fresh and enthusiastic.
However, if what works for me on a personal level is replicated by thousands of GPs nationwide then the overall effect is that of less availability and an increased pressure to recruit and retain GPs. Workload pressures lead to decreased hours, which in turn leads back to workload pressures.
What might be good for the NHS (me working full time) could also be good for my patients. If I worked more than three days a week it would be easier for them to maintain continuity of care with me.
But it may not be good for my health, my sanity and the happiness of my family, especially my young children who are always in bed by the time I get home on the days I do work. I have made choices and sacrifices that mean that I have been able to work less than full time for the last eight years.
What suits the individual GP doesn’t necessarily suit the NHS and the public it serves. Maybe I really am part of the problem.
Dr Samir Dawlatly is a former secretary of the RCGP’s adolescent health group and a GP in Birmingham.
