It seems that hardly a day goes by without GPs being in the national press. Whether it’s about us being well placed to address another public health or socially determined disease or a special interest group criticising us for not delivering to the standard that a super-specialist is able to.
No doubt influenced by politicians, the press tends to oscillate between calling GPs the saviours of the NHS (sorting out the spiralling costs, or dealing with the A&E crises) or its (idle, golf-playing) ruin.
But some journalists have finally sat up and noticed the workforce crisis. Yesterday I was interviewed by a BBC news team about the pressures that GPs are under, and I got the chance to explain to them the stigma attached to GPs with mental health problems, our tendency to work rather than take time off to recover, and the sad lack of confidential mental health services for doctors.
Like so many of you, my main concern for general practice is the health of our workforce, and making sure that we remain sane during these troubling times.
I left my role at NHS London to split my time between being a ‘grassroots’ GP and the Medical Director of the Practitioner Health Programme (www.php.nhs.uk) – a confidential service for health professionals with mental health problems.
Last year, general practitioners made up 41% of all of our patients (although we only make up 25% of medics on the GMC register). Many continue to come with burnout, depression, anxiety or just having had enough.
Pulse has been doing sterling work in identifying the rise in burn out amongst GPs and in highlighting the problems we are facing as a profession.
But knowing this is not enough. General practitioners, as with other doctors, find it difficult to look after themselves and address our own needs. Saying no is not something that we were taught at medical school and we constantly try and fix things for our patients, I am afraid to our own detriment. The reasons why we are so altruistic are deep rooted and over generations have served our patients well. However, now is the time to ‘pull your own oxygen mask down first’ and accept that we cannot save the NHS – or at least if we can, we must save ourselves first.
Against a dwindling budget and falling workforce numbers we are expected to work miracles with almost no resources – the feeding of the five thousand comes to mind.
We are expected to treat more patients, across more sites, over more hours, with a greater degree of complexity, and only a few ‘loaves and fishes’ (read: GPs, nurses and other clinical staff). Jesus may have been able to do it, but we cannot.
Recent figures show that the population of Britain has increased by around 500,000, meaning that to serve this new population we will require an additional 278 GPs – just to meet their basic care, in-hours. Even at the best of times, we have fewer GPs per head of population than comparable health services. The ‘inverse care law’ is alive and well in general practice funding.
The ‘new deal’ for general practice delivered in a fanfare by our Secretary of State, is far from a new, or good, deal. But cracks are appearing around the promises made – for example, Mr Hunt has already backtracked on his promise to train 5,000 new GPs, saying the figure is a maximum rather than a target.
In return for our ‘new deal’, GPs are now expected to work seven days a week – providing routine and emergency care. Of course this is magical thinking as given our inability to even provide five-day-a-week services,how on earth can we stretch to provide it seven days a week? No matter how loud politicians shout or how many feet they stamp, expecting a non-existing workforce to work extra hours is not possible. The maths doesn’t stack up: two times zero is still zero.
Next month PHP is staging a one-day event for burnt-out GPs, which includes presentations, workshops, and reflective sessions on mindfulness, addiction and resilience about how GPs can health one another to care.
In the meantime I leave it to our able medical leaders, Maureen and Chaand, to continue to fight for the best deal for our profession.
Professor Clare Gerada is a GP in south London and medical director of the Practitioner Health Programme.