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The Darwinian theory of evolution applies to general practice as much as it does to anything else. When an environment changes and a new niche appears, something will evolve to fill that niche. This has happened to us in primary care.
There used to be but one type of GP; he or she would work in a practice and see patients, because that’s all there was. But in the past couple of decades a new niche has appeared, an area that contains opportunities for bureaucracy, quangos, regulation and governance. And crucially, the chance to not see patients.
As a result, GPs have evolved into two tribes; let us call them, for the sake of argument, the Eloi and the Morlocks.
The Eloi tribe, of which I was a proud member, are those of us who do the clinical stuff. We like to see patients and make clinical decisions, we are available and accountable. We avoid politics and management. We are, in fact, what the public thinks of when they think of a GP.
The Morlocks are those of us who have missed our calling. They have found out, perhaps after some time of being exposed to it, that they don’t really like clinical practice, or patients, or working out complex problems on behalf of others. But hey! Nowadays, they don’t have to!
The Morlocks seek out committees. They go into management, medical politics and clinical governance, they spend their time devising ever more complicated protocols, they develop increasingly byzantine and infuriating regimes for appraisal and revalidation, they join CQC inspection teams and CCGs, they become clinical directors. They work for NHS England. They become MPs. They don’t see many patients. And they feed on the Eloi.
We could JUST practise medicine.
If they were left to themselves, as they are still just about in a minority, it would not matter so much. They weren’t usually good clinicians anyway. But no Morlock can justify their own clinical irrelevance without imposing their influence on the Eloi, which is having a serious and deleterious effect on the way we Eloi can do our jobs. Weeks and weeks every year are taken from us as we are forced to leap through Morlock hoops, collect nonsensical data for appraisals that are no benefit to anyone other than the Morlocks. We worry that a Morlock CQC inspection team will find something vanishingly unimportant in our practices that will absorb staff and clinician time (and they always do; every Morlock suffers from Witchfinder General Syndrome) and take us away from our true calling. And they are getting very good at doing just that.
One of the major problems in general practice today is access for patients. Waiting times to see a GP are becoming untenable and unsafe; practices are underfunded and understaffed. But I can solve this problem, ladies and gentlemen, in one fell swoop, at least temporarily.
I propose a complete moratorium, for the next full year, on every appraisal, revalidation, CQC inspection, meeting, new initiative, audit, everything that takes us away from the clinical coalface. We never used to have these distractions, so a further 12 months away from this nonsense will make no odds. We could JUST practise medicine.
In addition, all those Morlocks, deprived of their toys, could join us on the front line and do some bloody proper work for a change. They could go back to their own practices, or work as salaried GPs or locums, for exactly the same remuneration that they get for doing whatever it is they pretend to do now. Except, now they’d be doing something useful, in fact what the public is crying out for.
Waiting lists would drop, consultations could be longer, patient satisfaction would go up, health outcomes would improve, and those patients who say (justifiably, in my opinion) that they attend A&E because they can’t get a GP appointment would not be able to say that any more.
I can see no flaws in this. After a year, we could go back to the depressing system we’ve got now, where one part of the profession is doing its damnedest to demoralise the rest, but I suspect that enthusiasm for this would be low (unless you’re a Morlock). If we have to have appraisals and inspections, we could do them alternate years and halve the pain.
You see, Mr Hunt, I KNOW where the extra 5,000 GPs you have promised by 2020 actually are. They’re hiding in plain sight. They’re there, but not doing anything that a normal GP would construe as useful work. And they’re sitting on a committee near you.
Dr Phil Peverley is a recovering GP in Sunderland
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