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No rest for the wicked GP



I find myself conflicted. It doesn’t happen that often as my husband will confirm. But I am wrestling with myself over a perplexing situation. Not a patient with tricky diagnosis, or an ethical dilemma. No, it’s tea breaks. Or more precisely the RCGP’s latest campaign, which compares GPs with pilots and HGV drivers in highlighting that fatigue affects safety. I’ve watched the reaction online with interest, and largely resisted commenting, mainly so I don’t get any patronising responses from ardent fans of the college, but also because – well – I kind of like it.

I firmly believe practices where GPs make a determined effort to take a break to share a quick brew are happier places to work

Don’t die of shock just yet. There are caveats. I firmly believe practices where GPs make a determined effort to take a break to share a quick brew are happier places to work. When I’m locuming, I can tell within the first 10 minutes whether the practice is the type of place that has a tea break, or a place where doors shut and don’t reopen for the duration. I suspect many of us used to meet over the visit book, chat/complain about the morning’s surgery, exchange a few pleasantries. But with the advent of IT systems meaning visit books are long gone, and the fact there’s barely time to eat or pee, let alone have a leisurely cuppa, it’s a lost art.

So it was I found myself nodding in agreement at the thinking behind the college’s latest posters. It is unsafe to work when overtired. We are firefighting and lurching from one near-miss to the next, just waiting for that complaint or missed diagnosis that will catapult us to the GMC.

But here’s the rub. The campaign does have a valid point, but it misses the crux of the matter. You can’t compare NHS primary care, with its all-you-can-eat approach to healthcare, with a safety-oriented and heavily fatigue-aware industry like aviation. Pilots will not fly without adequate rest. They are not criticised for this; indeed the RAF has serious penalties for staff who fail to take their scheduled rest breaks due to overwhelming evidence of negative outcomes for fatigue. For GPs, though, fatigue, illness and personal issues are traditionally shoved under the carpet. Working part time is just about acceptable, but no one really wants to work with a colleague who won’t soldier on through any illness that doesn’t involve the forceful ejection of bodily contents. Arguably that was why Imodium and Stemetil were invented anyway.

Also, our ‘customers’ as patients now seem to be called – and I’d lump politicians in there too – have little time or sympathy for our plight, given their tabloid-skewed perception of what we do. And once again it feels like it’s our fault. Your GP will make mistakes if they are tired. If they cock it up and kill you it’s down to their failure to take breaks. Maybe I’m oversensitive. But I’d love to see a campaign with a tag line like ‘General practice collapse imminent – who will treat your family?’, or ‘NHS failing – can you afford to go private?’

For all its good intentions, this campaign feels like another shot in the wrong direction. Maybe the college can learn from the RCOG’s fiery message to the Government over the junior doctors’ strike, and clearly show whose side it’s on. Let’s discuss it over a cuppa.

Dr Zoe Norris is a GP in Hull