PUT UP OR SHUT UP………..

So, apparently we need to stop moaning and whingeing about General Practice, or we won’t attract the new recruits; that’s the latest arrow winging from Westminster.

No recognition of the fact that we are all struggling at the moment, just that we need to shut up about it.

No mention that to move forward with mute acceptance and obsequience would be like bringing the next round of GP lambs to the slaughterhouse, completely unequipped and unaware of the trials to come.

Okay, so rather than let our emotions get the better of us, let us look at this problem in the form of an employee appraisal (though of course we aren’t employees and perhaps therein lies the problem for the government).

Occupation: GP

Duties & Responsibilities:

• To be the main point of healthcare contact for the whole population within the UK
• To manage both scheduled and unscheduled care both within and outside normal working hours
• To keep updated in all areas of medical knowledge and skill to ensure that care provided by other organisations is of an appropriate standard
• To manage co-morbidity, co-ordinate care, manage acute and chronic illness, health promotion and disease prevention
• To be the patient’s advocate and maintain an holistic approach
• To prescribe not only safely, but in line with this year’s local and national guidelines and in the most economical way possible
• To run not only a business budget of £9bn, but be responsible for the commissioning of the majority of NHS services
• To be involved in the continuing development of the healthcare system

Achievements in Past Year:

• Number 1 in latest Commonwealth Fund Report despite increasing consultation rates and decreasing resources
• Took over commissioning NHS services
• Coped with increasing demand whilst maintaining quality

What do you find Interesting:

• Intellectually stimulating and rewarding
• Challenging
• Still most trusted profession
• Degree of autonomy and flexibility especially with career path as generalist but with ability to sub-specialise
• Satisfying and ‘Every day is different’
• Tremendous variety of medical and other issues to manage
• Holistic approach empowering Patients to manage their own health
• Opportunities for a great variety of different roles to suit any time commitment, pocket or interest: out of hours GP, salaried GP, GP partner, commissioning, politics, journalism, sexual health, family planning and numerous other clinical roles, occupational health, developing information technology, property investment, entrepreneurship, management, service design, teaching medical students and training junior doctors.

Challenges in the Past Year:

• Annual contract changes
• Increasing climate of abuse from government, media and patients
• Problems with retention & recruitment due to career uncertainty, increased retirement and emigration, and falling income
• Constant inspection by multiple agencies
• Increase in spurious complaints
• Increase in bureaucracy and mindless box ticking exercises
• Decrease in autonomy
• Increased threat of litigation though exhaustion doesn’t preclude prosecution
• Spiralling workload and unreasonable demand
• Reduced respect for clinical judgement; as the alternative is testing and referral, this threatens the financial viability of the NHS
• Annual appraisal & revalidation process
• Lack of support for business/commissioning processes
• Yearly reduction in pay and resources
• Reduction in pension and increase in retirement age (incidentally is it really wise to push a clinician with potentially declining mental faculties to play Russian roulette with people’s health?)
• No occupational health service
• Rising divorce, alcoholism, mental health, suicide & drug misuse rates

What Have Been Your Goals for the Past Year:

• Survival

What Are Your Goals for Next year:

• Foster resilience within Primary Care
• To engage secondary care so that we can work together
• Engage the public to take control of their own health. (That Holy Grail of self-care)
• Redress the wants versus needs culture

So Whitehall, we’ve completed our appraisal document, over to you.

Somehow you need to create a workforce of enthusiastic, willing doctors who are prepared to keep polishing the jewel in the NHS crown, not a bunch of beleaguered, vilified, despondent scapegoats who are looking for the closest exit.

It’s about time we all stood together as a workforce to say “enough is enough”.

You can’t ignore the elephant in the room any longer. We ARE exhausted, drowning and furious, but we haven’t given up yet because for most of us, being a doctor is vocational.

We are proud of General Practice and of looking after our patients to the best of our ability.

We want to see Primary Care survive, not thrown to private providers to tear it limb from limb, leaving a rotting carcass behind.

It would be a betrayal of our professionalism if we did not make this clear to everyone - politicians, the public, and potential future GPs.

So, stop hiding behind the rhetoric and unfulfilled promises, we say again, what ARE you going to do about it?