Thirty years ago I was a young GP. If a medical student had asked me about career choices I would have been very enthusiastic about general practice. We had high status in the community, the workload was significant but manageable, the salary was that of a professional person. There was security in the job. External management was light-touch but competent.
Thirty years ago I was setting up a diabetic clinic in my practice. I worked on it in collaboration with a local diabetes consultant who was keen on joint working, and trusted us to develop high standards of care. We looked after our own on call, being responsible for people every hour, every day, all year round.
It is hard to convey what it was like then to the doctors of today. I do not have the writing skills of an A J Cronin or a Francis Brett Young to describe what it was like, but I was happy and fulfilled. I was a young man then. I was able to look at the more experienced doctors and imagine what life would be when I was their age. There were many working in their seventies, and doing a good job.
I was able to go home for lunch and see my young family growing up. I had time to pick my young daughters up from their primary school.
The work was busy and challenging; I would spend some nights in and out of the local GP maternity unit working with experienced midwives to assist with (and sometimes deliver) babies.
The doctors I worked with were a community; we had annual BMA dinners, and met at postgraduate meetings each week. We respected our neighbouring GP practices, and didn’t see them as competition. Illness and early retirement was rare.
That was then.
I look at where we are now. Much of what we experienced then is now history. GP maternity units have gone, consigned to wither away thanks to an ill-judged report written by a Government stooge with an agenda. That stooge is on the Tory benches in the House of Lords now.
Going home at lunchtime is now a joke. I cannot remember the last time I had enough time to do that, and certainly I would not be able to pick up my grandchildren from primary school. Socialising with other GPs is a real rarity, and there is no local BMA dinner any more. Education tends to happen late at night, alone, with a computer and a website.
Over the last nine years, our income has been frozen. The mandarins and politicians at the Department of Health have imposed this as a result of the cack-handed 2003 GP contract which abolished the ‘Red Book’ and gave ministers and others unprecedented control of GPs’ lives and working patterns. They have continually abused that power to achieve their short-term, politically-driven goals.
When I was deciding my future 30 years ago, I looked at the senior people in my profession, and looked at their lifestyle and satisfaction, and I liked what I saw in general practice – good work-life balance, professional autonomy, respect and happiness. But consultant colleagues were much more miserable: that helped me decide.
Now what I see is more troubling. GP colleagues are retiring earlier, and suffering more ill-health. There is a feeling that full-time general practice is virtually impossible to sustain for any length of time. In my patch it is becoming rare for a GP to be over 60, full-time and happy.
That’s why I’m retiring.
The Jobbing Doctor is a GP in a deprived urban area of England