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The good, the bad and the ugly of general practice



General practice in the UK, and England in particular, is in a right conundrum. We just don’t know how to describe ourselves. On the one hand, there are the well-documented, blogged-about, discussed and reported issues around workforce, workload, funding and regulation. It is easy to have a moan and point out all that is not well with the profession. But at the same time, there is a concerted drive to recruit more unwitting doctors to this profession, that seems to have been perpetually in crisis for over ten years.

Before I even started training as a GP, I asked a GP what he thought the biggest threat to general practice was. It was a couple of years after QOF had been introduced and his answer was: ’Nurses. They are going to take our jobs.’ Even the wisest of GPs don’t have a crystal ball or the ability to predict the future.

The ability to declare a crisis has undermined general practice for years. I can almost hear Matt Hancock Skyping one of his advisors: ’What? A crisis? But didn’t they say that last year? And the year before that? What’s it about this time? Well just tell them we’ll find an app for it and give them some money to rearrange their deckchairs…’ We all know that a crisis is not a crisis until someone rich or famous dies.

So, we are left with a profession where a large chunk are doom-mongers, but don’t know how to do anything about it. And if they make too much noise about it they’ll get a sharp elbow and a seething rebuke: ’Shut up with your moans, you’re only going to make the workforce crisis worse.’

The ability to declare a crisis has undermined general practice for years

And while the nihilistic realists try to decide whether to be honest about their workload, the mindless optimists at the other end of the spectrum are gleefully unpacking their online video consultation apps and networking in their networks. After all, John J Kennedy famously said, ’In a crisis, be aware of the danger – but recognise the opportunity.’

In the week when mainstream media was running Pulse’s stories on GP workload and workforce issues, before they were shunted from the public consciousness by Brexit, scandals and other clickbait, I ran a workshop for medical students on general practice as a career. I was honest about the good, the bad and the ugly of general practice. They had plenty of questions and managed to stay awake despite their hangovers (they had their exam results the day before).

I wish I had the solutions, not just for the students, that would fix general practice, especially for keeping hold of new recruits and wise older hands. It’s great, it’s crap. It delights, it frustrates. It defines, it destroys. It’s a conundrum.

Dr Samir Dawlatly is a GP partner in Birmingham