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Pulse Live: Spreading the resilience



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17.00 Finally, the moment we’ve all been waiting for, the interview with Charlie Massey of the GMC. And the questions we’ve been waiting for, too, such as, ‘What are GPs to do when our workload makes it unsafe to practice?’ Answer: ‘We need to be a sharper voice in the commenting on workforce pressures and do need to make sure we take context into account.’ Which, frankly, won’t have me sleeping much easier and certainly won’t ease my migraine on a Monday morning.

Some shared ground, though: Mr Massey is perplexed by Jeremy Hunt, just like we are. That was in response to Mr Hunt being perplexed by the GMC’s actions in the Bawa Garba case. So Mr Massey was perplexed about Mr Hunt being perplexed. Although the irony was that Mr Hunt being perplexed making Mr Massey perplexed was one of the few occasions that we GPs weren’t perplexed about Mr Hunt. Because, for once, we agreed with him.

Anyway, we now know that the GMC’s actions in the case weren’t for fear of what the Daily Mail might have said on their front page, because our esteemed editor asks him and he says, nope. So that’s put that one to bed. Other questions were equally tough and deftly, if not definitively answered, such as, ‘Can you give me any evidence that revalidation improves patient care?’, ‘Why are BME doctors over-represented at GMC hearings?’, ‘What is the GMC doing about suicides in doctors under investigation?’ and ‘Why should doctors fund the GMC?’

With pleasing symmetry, the talk comes full circle from the morning, back to resilience. ‘I’m concerned about discussions of resilience as that personalises it as the doctor’s problem,’ says Mr Massey. Which is fair enough. So plenty to ponder on, and ditto for the GMC. As Mr Massey points out, with regard to Bawa-Garba, ‘there are a lot of reflections we’ve had.’ I wonder if he’ll write them down?

14.30 The afternoon was going to kick off with Pensions but, who’d a thunk it, I couldn’t get in. Which probably tells you everything you need to know about the average GP’s mindset at present. So, instead, I had to run to the ‘Physical activity promotion in primary care’, session, causing sweating, tachycardia and extreme irony.

It didn’t end there, because the superb Dr Dane Vishnubala wouldn’t allow a show of hands for various questions, instead insisting we voted with our feet, ie, getting us up and down out of our seats. Exhausting. Whatever he’s doing/eating I’m going to do/teach because, as well as being informed, motivational and entertaining, he doesn’t look a day over 12.

And so to Medical Indemnity which I did get into, but only just. Standing room only, causing me such backache that I couldn’t concentrate, so nothing to report. Sorry. I may sue.

12.15 And finally for the morning, ‘General practice in crisis, what are your options?’ Which I can summarise with ‘Quit’ or ‘Merge’, although the latter is slightly at odds with the conclusion of this morning’s debate on ‘Bigger’.

Time for lunch, which if my coffee break experience is anything to go by may well be a mime of a baguette.

11.30 Dispatch from the coffee break. Some weird stuff going on. There are groups of staff standing behind signs that say things like ‘cheese ploughmans’ and ‘chicken mayo’. Yet it is not lunchtime and there are no signs of sandwiches.

If you want to find them, they are near the massage stand and the one that has something to do with anogenital warts. They are not taking orders and they are not sure why they are there because I have asked them. It may well be a piece of performance art and rest assured that I will alert you to any further developments.

In the meantime, it’s on to ‘What do you do when you can’t close your list?’ Turns out I was right with my earlier answer because one of the options really is ‘panic’. Others include, apparently, retire, emigrate and join the foreign legion. Or, of course, contact your LMC – judging by this talk, an excellent option, as our speaker cleverly highlighted some neat loopholes we can exploit. They might not save us, but they will at least make our professional death more entertaining.

11.00 ‘So how many people think bigger is better?’ (with regards general practice) asks our esteemed editor as a pre-debate show of hands. No count required because the answer is zero. OK, maybe one, though I think that was the speaker for the motion, Dr Vish Ratnasuriya. Modestly, or maybe realistically, he says he wants to move the needle rather achieve a mass conversion and certainly scores with his metaphors: we need a flotilla of small boats rather than a supertanker, he says.

Dr Michelle Drage, flying the opposing the motion flag, points out that smaller practice size is directly related to patient satisfaction. A very patient-centred viewpoint for a room crammed with GPs, perhaps, but that’s what’s important, right? Oh, and GP job satisfaction is better, too, so even better.

Of course, much of what we hold dear about general practice is shared across big and small, as both speakers and audience point out. Besides, it all boils down to what we mean by ‘Bigger’, in which case I can only repeat, as per previous blog post, oo-err.

So some doubt about ‘big’. But no vacillating with the question in my next session, ‘What is resilience?’ I can now tell you categorically what resilience is. It’s medium carbon steel. That is, a steeliness that combines toughness and flexibility.

Another insight to our current angst from excellent speaker Prit Buttar involved him pointing out that there are no longer the quiet moments and days to make up for the horrendous moments and days – it’s relentless. Sound familiar? Well, here’s a tip from the session. Ask yourself with your heartsinks with intractable psychological problems’ ‘What value am I adding?’ If the answer is, as it will be, ‘Not much’, then stop doing it and do something more useful instead.

In my case, that doing something useful instead may well be having a coffee, and is a practice-changing idea that I’m going to implement asap. Or, at least, as soon as I’ve checked my iron/carbon ratio.

09.30 If you needed evidence that ours is a profession suffering a crisis of doubt – about our future, our role and our ability to get through tomorrow’s inevitable torrent of disease, dysfunction and despair – then look no further than Pulse Live, which kicks off exactly now. Specifically, the ‘Your Practice’ stream, which I have pencilled in as my morning’s entertainment.

Because every session is headed up as a question: ‘Is bigger better?’, ‘Resilience in general practice – what does it mean?’, ‘What do you do when you can’t close your list?’ and ‘Primary care in crisis, what are your options?’ At this point, I’d say, ‘Oo-err’, ‘Not having to rely on SSRIs’, ‘Panic’ and ‘Pray’, respectively. But maybe I’ll be more enlightened by lunchtime, so I shall try to convey my insights through the medium of a half-chewed chicken sandwich.

In the meantime, I’m just trying to cope with the survivor guilt of being here while my colleagues back at the ranch fend off the Essex hordes. I feel your pain, and I shall try to bring back some resilience. Whatever that is.

Dr Tony Copperfield is a jobbing GP in Essex