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Why I hate the Pulse Power 50



It’s that time of year again, when the annual Pulse Power 50 love-in arrives to fill the void normally filled by health secretary bullshit and happily emptied by the parliamentary recess.

Think about all the GPs you’ve ever met. Imagine they’re all in a room together, like a ballroom or something (no doubt talking about pensions). I want you to try sorting them into a long queue, with the ‘best’ GP at one end and the worst one at the other. Bit tricky innit?

How would you go about such a thing? You don’t really know these people. Our work takes place, for the most part, out of sight of our peers. You’ve probably only seen a handful of them actually consulting. Any attempt to catalogue them will rely on gut feeling and prejudice.

And how do you even define ‘good’ in this context? We’re all multifaceted individuals with our own strengths and weaknesses. Some of us can give chapter and verse on the latest NICE guidance but struggle to take a history. The colleague we suspect must have sourced their MRCGP certificate via the dark web is the only one who can fix the coffee machine, while the guy who gives off borderline sex case vibes partially redeems himself by knowing a shitload about dermatology. How do you decide which particular attribute warrants pole position?

For us minions, the only thing worse than being bossed around by someone who used to be a GP is being bossed around by someone who didn’t

You can’t. But the Power 50 isn’t even about the ‘best’ GPs – that might be an accolade worth winning if we could judge it. No, this is about the most ‘influential’.

I found myself thinking about this in 2017, when my own surprise appearance in the Top 50 (at number 45, no less – in your FACE, numbers 46 through 50!) showed me that the list definitely had merit. On perusing the rollcall of the great and good, I noticed that few, if any, of my fellow nominees were working full time in practice. You see, the Pulse Power 50 isn’t a list of the best GPs; on the whole it’s a list of people who happen to be GPs but are now doing something else deemed worthy of appreciation.

The more of that other, new, thing you do, the higher up the list you go. Which means, perversely, the best way to get onto the Pulse Power 50 is to stay as far away from actual GP work as possible while still nominally calling yourself a GP.

Former doyen of Pulse columnists Dr Phil Peverley infamously designated these coalface-avoidant colleagues Morlocks, preying on the rest of us Eloi who do the donkey work, and he makes a persuasive argument.

But there are two reasons why I think Phil’s view is unhelpful, and so am willing to cut the Power 50 a bit of slack.

First, for us minions – whom I’ve dubbed the Pulse Impotence 44,897 – the only thing worse than being bossed around by someone who used to be a GP is being bossed around by someone who didn’t. If you don’t want non-clinicians or politicians dictating to you, you’ll have to accept that GPs are going to go into management.

Second, full-time general practice is currently so toxic to the long-term physical and mental health of its workers that we really shouldn’t be putting it on a pedestal, as if it’s some nirvana to which all should aspire. If someone has carved themselves a safe niche away from the many mandatory interactions with literal and figurative arseholes that render the job so unpalatable, shouldn’t we find a way to applaud them for it?

Which brings us back to the Pulse Power 50. Maybe we get the role models we deserve.

Dr Pete Deveson is a GP in Surrey. You can follow him on Twitter @PeteDeveson