I’m sure I’m not the only GP who’s despaired at times about the standard of representation of those bodies who direct policy that influence my day-to-day work as a grassroots GP. Bizarre NICE guidelines that seem to come from someone practicing on Planet Zog; odd pronouncements of what we’re ‘ideally placed’ do from the RCGP… the list of policies released that at times feels very disconnected from the realities of the frontline is depressingly long. At times, one wonders how committees arrive at these decisions, and whether anyone who actually works at the coal-face most days was involved.
And that’s part of the problem – many of these bodies expect GPs to volunteer their time for free. The RCGP Council is made up of members who are elected, willing to give up a Saturday each quarter (plus reading the papers before) without any form of payment. Only this week, a colleague posted a message on a social media group asking for GPs to volunteer to join the All Wales Prescribing Strategy Group – unpaid, of course. I recall being asked to be a GP ‘veteran’s champion’ for my local health board planning group – no funding attached to the role, of course.
On most of these committees, which are multi-disciplinary, the managers and hospital staff attending are doing this as part of their paid employment, not as a free extra. Yet GPs are expected to do it for free often, and people turn a bit uncomfortable when asked what payment is made to participate. Now, either we’re valued equal contributors, or we’re an afterthought, and the subliminal message is that we’re optional extras – and as long as someone offered to have a token GP come forward, if none stands, well, no matter: ‘box-ticked, consultation process achieved’.
But there is a wider concern: while I have nothing but admiration for those members who can afford to do this work for free, there’s a risk we’re selecting a subset of the profession who have the capacity to do this work unremunerated. For example, how many locum GPs who work less than full time, perhaps due to caring commitments, illness or disability, are able to give up this time? What about the pressured single-handed inner-city GP? Are their voices heard? I’m not so sure. So it’s the wealthy GP, or academic GP, who can serve as part of the day job, or part-time GP with the working partner who come forward to volunteer. Many of the rest are too exhausted and stretched to be able to stand.
It wasn’t until the Parliament Act 1911 that MPs in the House of Commons were paid a salary. Until then, one needed independent wealth to stand for Parliament, which severely restricted the voice of working people and limited true representation. While clearly not of similar importance, medicine as a profession, but especially the voice of ordinary general practitioners, will be limited and distorted until payment for all representation on committees becomes the norm, not the exception. This will then attract the most worthy candidates to stand for these roles, broaden representation and avoid the risk of groupthink that too often persists in our profession today.
Dr Alan Woodall is a GP in Wales and founder of Resilient GP and GP Survival