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What do GPs owe the NHS?



The one thing I told my team to look out for in the health secretary’s speech at Conservative party conference was any sign that he would be compelling trainee doctors to work in the NHS. My prediction proved correct.

I doubt many GPs feel particularly valued by the health service at the moment

Jeremy Hunt announced in Birmingham that medical graduates would be obliged to work in the health service for four years: ‘This mirrors the approach taken by the Armed Forces,’ he claimed, brandishing the £220,000 in public money that it costs to produce a graduate from medical school.

But let me unpick that statement a bit. There are some definite similarities between a soldier and a doctor: a highly developed sense of public duty, the mental toughness to save lives and a capacity to work in what could be classed as ‘war zones’.

A standard bursary for an undergraduate degree course is £6,000 from the British Army and comes with the expectation that the recipient serves at least three years after graduating. But medical students don’t receive direct financial help – in fact they pay around £40,000 in tuition fees and graduate with debts of up to double that sum.

I studied at a time when some students had grants rather than loans, but if anyone had suggested to me after I completed my BSc in physiology that I would be compelled to work in publicly funded research labs for three years to ‘pay back’ my tuition I would have laughed in their face. So what makes the medical profession different?

I am sure many GPs would agree that being a doctor does involve a sense of public service and deep loyalty to the NHS. But I doubt many GPs feel particularly valued by the health service at the moment. There has been a sustained defunding of practices over the past decade and a Pulse survey last year showed half of GPs to be at high risk of burnout. In this toxic environment, is it fair to expect GPs always to ‘put country first’?

And while trainees may soon not have the choice to leave the UK health service, already qualified GPs do. And this presents an ethical dilemma. In a major investigation launched today, we look in detail at the expansion of the private healthcare industry, and this includes private GP services.

The recent launch of an ‘Uber-style’ online GP service is symptomatic of a wider shift in the way healthcare is provided, away from the taxpayer-funded model that has dominated since 1948. But these models can only succeed if GPs are willing to work in them.

The Doctaly service relies on GPs using their own surgeries to carry out consultations (not with their own patients of course). And the new GP version of Deliveroo – GPDQ – deposits a fully trained doctor on your doorstep within 90 minutes for the price of £120.

Here it behoves me to mention the extra £2.4bn pledged in the GP Forward View in England and the £500m promised in Scotland by 2020. But this crisis of morale is happening right now. There is a real risk that ties between the profession and the public sphere are being irrevocably eroded and that the health service has taken its GP workforce for granted for too long.

It would be a disaster for the NHS, but could anyone blame GPs if they looked at the way they are treated now and decided to forget their ties to the publicly funded health service and seek better pay, conditions and respect in the private sector or abroad?

Nigel Praities is editor of Pulse