The Issues that Jobbing GPs are Annoyed About

With the recent inauguration of the 45th president of the United States I thought it would be pertinent to write a starkly honest and transparent politically agnostic piece about the current state of general practice. All too often we read articles about the dire state of general practice which usually have a juxtaposition and somewhat rose-tinted final paragraph which aims to 'rally the troops' and encourages us to fight, campaign and picket for our profession. At the other end of the spectrum we have some medical magazines which are overly pessimistic and discuss nothing but doom and gloom [1,2].


Short Commentary
With the recent inauguration of the 45th president of the United States I thought it would be pertinent to write a starkly honest and transparent politically agnostic piece about the current state of general practice. All too often we read articles about the dire state of general practice which usually have a juxtaposition and somewhat rose-tinted final paragraph which aims to 'rally the troops' and encourages us to fight, campaign and picket for our profession. At the other end of the spectrum we have some medical magazines which are overly pessimistic and discuss nothing but doom and gloom [1,2].
Over the past five years General practice has faced a myriad of challenges which have taken their toll and left it in and almost preterminal state. It seems to feel worse than it did in the run-up to 2004 when the reset button was pressed and the new contract was issued. Fortunately, at that time, there were the resources available to be able to transform general practice and make it an attractive career option. I recall GPs reporting that they were fairly remunerated and workload pressures were reduced in the years following the issuing of the new contract. Hospital doctors were leaving their esteemed training posts in secondary care and entering general practice in their droves. Training schemes were oversubscribed and our specialty was one of the most popular of career choices. A perfect example of the cyclical supply and demand system. Times were good; as they should be [3].
Over the past few weeks we have had heartfelt communications from our local medical committee and the RCGP faculty thanking us for our dedication, goodwill and hard work we do as GPs to prop up the NHS in the face of most challenging times. There has been a recent boom in mindfulness and resilience programs for GPs. Although I am a staunch supporter of these psychological principles, their recent popularity may possibly signify an impending implosion of general practice. There is most definitely an appropriate time for mindfulness to bolster resilience but I fear that there isn't enough mindfulness in the world to get us out of the situation we are in at the moment.
Please don't even get me started on: the unresourced dumping of work into primary care, farcical enhanced services, endless box-ticking red tape, CQC, estates, appraisal/revalidation, no-win-no-fee vindictive/vexatious complaints, the media-bashing of General Practice, and lifestyle-driven health epidemics.
I admire those individuals who devote their life to conceptualizing novel models of care in an attempt to radically rescue the NHS from crisis. However, these initiatives seem to be nothing more than skirting around the edges of the issue. I love the NHS and I'm proud to work within it [4]. What saddens me is to see it slowly being thwarted, abused and starved into extinction like a beautiful endangered species. The fundamental problem faced by the NHS and general practice is that it is woefully underfunded and not equipped to effectively deal with the demands of modern day morbidity, public expectation and fragmented the social care in society. Spending millions of man-hours trying to save pennies is not going to plug the gargantuan billion pound black holes which exist in the NHS. Hitting jobbing GPs with the cosh of impossible QUIPP and unplanned admission targets is nothing more than clever accounting creating the illusion that a circle can be squared. It is like the child spreading their food around the plate in and attempt to convince their parents that they have finished their meal. And just when you think things can't get any worse -a few days ago there was a further ill-informed political and media attack on hard-working GPs with threats from 'on high' that our funding would be cut if we did not provide an eight-till-eight seven-day service. Did the government somehow confuse the term 'support' with 'hitting a man whilst he's down'? The mind boggles! Am I confident that if I asked GPs to put their hand on their heart and say that they are proud of their profession and career that 99.9% would say, "yes"? Yes, I am. Would I expect the same response if I asked them if they are confident in sustaining their current workload under extreme pressure and in a broken healthcare system? The answer to that question is evident by the droves of GPs who are emigrating, retiring early and burning out. Not to mention those doctors who aren't even considering entering into our profession [1,5].
I am no medico-political pundit. Nor do I possess a crystal ball. Some experienced GPs are advising to 'sit out the storm' as sunny skies are forecast. Do I have the answer of how to heal the health system? No. I am not going to end this article by trying to convince or patronize you with'Trumpism' like, 'We can make our NHS great again' -unlike our medico-political 'representatives'/leaders who often sit in their ivory towers with vested political and personal interests. What I can confirm with confidence is that we are highly valued pillars of the NHS without which it would collapse within 24 hours. We also have to remember that most of us are all fathers, brothers, mothers, sisters, sons and daughters with familial and financial commitments and responsibility [6][7][8]. Conclusion Being the caring altruistic people we are, we instinctively put society and our patients first. We need to continue to do the right thing but not at the expense of our own wellbeing and our loved ones. We need to start seriously considering our options as the cracks in the system transform into chasms around us.