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General Practice “won’t get any more sustainable”

Simon Gibbs

A former Bradford GP lambasts the NHS GP system in a letter to Pulse:

I [left General Practice to work in a Hospice] for several reasons. Gone is the relentless pressure to move onto the next patient. I have taken a significant pay cut, but I don’t care, this job at least does not treat me like something you scrape off your shoe. I start at 9am, get a lunch break, and I get to lavish time on my patients.

What would it take to induce me to return to general practice? Even as I ponder the answer, I know it’s futile. The job won’t get any more sustainable with seven-day opening, and a dwindling number of colleagues. No. I’m done.

Read the whole thing.

Tags:

Direct Care, NHS

Date:

June 10, 2015

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6 responses to “General Practice “won’t get any more sustainable””

Julie near Chicago

June 11, 2015 at 8:00 am

Good posting from Dr. Mounce, Simon. I see his colleagues report the same in the comments. It’s a shame. Everybody loses.

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Mr Ed

June 11, 2015 at 9:42 am

Is the sort of patient that Theodore Dalrymple used to write about becoming the norm in the GP’s waiting room? Or is it the combination of an endless queue of people, medical wheat and medical chaff, waiting to be seen, with a claims culture providing a stream of people wanting to be ‘ill’ for their own purposes. I wish he had said more about the factors that got to him, perhaps the depressing people, the depressing powerlessness for those who are ill, perhaps the sheer drudge of working on a State-funded contract, demanding of a patient with a foot injury from, say, gardening, to know how much they drink, and then mentally doubling the amount stated in response if not zero.

I know of one private GP who enjoys GP work. Perhaps because patients pay they are (i) almost always genuinely symptomatic and (ii) at the higher end of the ‘social scale’, and time is not rationed in the way that a ‘free’ service is, where you pay with your time as the queues subside.

However, it would seem to be that having a 7-day rota for medicine in pretty much any field apart from elective cosmetic surgery is something that should have been an obvious likelihood to bright teenagers filling in their forms for medical school.

The question is, I suppose, when will people really start to question the presumption behind the NHS? and the next one is, ‘How can we advance that occasion?”. Every post like this is a start.

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Paul Marks (@paulvmarks)

June 11, 2015 at 11:23 am

The terrible thing is that there is nothing we can do – nothing. The NHS is a religion to the British people – to criticise government health care (apart from saying that it should be given more tax money) is blasphemy.

So all we can do is watch, helplessly, as more people suffer and die.

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1. Mr Ed
  
  June 11, 2015 at 3:40 pm
  
  “The NHS is a religion to the British people – to criticise government health care (apart from saying that it should be given more tax money) is blasphemy.”
  
  That is certainly the media narrative, and despite a mountain of corpses flowing prematurely from the NHS, that is what we understand to be the ‘public perception’ (or perhaps, the mode in terms of the response to what to do with the NHS, but let us hope that the reality is that many realise that the NHS is a danger to many and that they would at least be open to question firstly the model and then the premise. How much more evidence of the brutality of the system is needed? It is not hidden, the information is all there. Perhaps people know but do not wish to consider the issue, an SEP. (Somebody Else’s Problem, the great invisibility cloak).
  
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ZachCope

June 11, 2015 at 8:54 pm

Hi all, I’m back, although I’ll come straight out and say I’ve concluded I’m more a classical liberal more than a libertarian. Regardless, as someone who pushes for more private funding of health, preferably by the end user in some way, it puts me squarely at the radical end of UK political discourse with all of you!

Paul is right of course that the NHS is treated as a religion in the UK. Douglas Murray’s Spectator piece recently is spot on (http://www.spectator.co.uk/features/9547992/doctors-orders/) and in a recent podcast he makes the point that the NHS is held to ridiculously low standards. Often patients say ‘I would have died if I didn’t go to that hospital’ or ‘before the NHS I wouldn’t have been treated’. The former fails to point out that if the hospital was closed they would have gone a few miles down the road to the next one, and the later forgets that in nearly all of the rest of the world, including much of socialist Europe, an element of patient contribution is the norm yet there is universal healthcare coverage. The IEA have published a useful document on this recently (http://www.iea.org.uk/sites/default/files/publications/files/CC_What%20are%20we%20afraid%20of_web_3.pdf), helpfully not comparing with the oft quoted USA (we know that’s broken) but instead using Holland, Switzerland and German examples of care.

I like to think the Spectator piece by the way ‘Treat the NHS as a religion, and you give it the right to run your life’ is inspired by some of the discourse here ‘https://libertarianhome.co.uk/2015/03/think-of-the-health-consequences/’.

A few points:

1. Mr Ed writes ‘is it the combination of an endless queue of people, medical wheat and medical chaff, waiting to be seen, with a claims culture providing a stream of people wanting to be ‘ill’ for their own purposes.’ He illustrates a particular concern of mine that, across the political and public discourse we are increasingly being encouraged to judge each other’s worth. I see a parallel between the rise of reality TV voting shows in recent decades and the idea of ‘eligibility’ in public services. Thus every health article will include ideas to educate people to use services properly, along with criticism of those using services inappropriately.

To be honest it’s hard enough to work out what’s wrong with people in 10-15 minutes even with 12 years of training a 5 years of unsupervised practice, so I have more sympathy than most in this area. Rather than wanting to be ill I propose that there are many who develop real illness (chronic pain, depression and anxiety) due to the real financial and societal incentives for them to do so. Housing benefit, for example, is much easier to secure if on ESA than Job Seekers allowance so, for someone who is almost unemployable they are making a subconscious yet entirely economically valid choice to become chronically ill.
It was in such a consultation that I realised just how destructive means tested benefits are to individuals.

Also the general government and media message is that ‘you can’t be too sure’ so why should someone restrict their use of a service where the marginal cost if £0 + your time waiting to be seen? (Doctor’s tip – you can be too sure.)

2. The hyperbole here about mountains of corpses, suffering and death is probably unhelpful. The NHS isn’t bad, and the clinicians working in it are not inherently devoid of compassion and skill just because the state funds the service. It just could be much better.

There are problems however, the biggest being that the total funding for £65m people is set centrally, with no escape valve of top up payments or patient contributions to respond to areas of demand.

Take extended GP access for example. This sounds like a good idea, as workers as businesses may benefit by being able to access non urgent health care out of routine office hours. The lack of a way to capture the value, for example by that new fangled price signal of ‘money’, means that day time services are at breaking point at the same time as evening and weekend services are being expanded at a higher cost/appointment cost!

My current favourite analogy is that of an aeroplane. All passengers arrive at the same destination, just as safely, flown by trained pilots, in a well serviced plane that won’t fly if unsafe or if no one has paid for the petrol. Some passengers, however, pay more for convenient flight times, better service, later booking and a choice of seats. The is no reason that a basic insurance, whoever pays for it (state, private company, mutual organisation) can’t offer upgrades and add ons to capture the benefit to those individuals, yet making the whole flight more viable. The problem in the NHS however is that this can’t happen, and we are forced to fly on with a cramped airline, tired grouchy staff, a poorly serviced plane, half a half tank of fuel and, most importantly, crappy food.

One further point of interest. It seems the idea of leaving the NHS is becoming more interesting to more UK GPs. The comments from yours truly and others on Pulse and the GP forum on doctors.net.uk have more and more GPs pushing for ‘the Guernsey option’ or ‘doing a dentist’ and resigning on mass from the NHS. As finances get squashed even more, and ‘free’ GP access becomes only accessible with those with the time or influence to get appointments, this could turn out to be the way to save the important medical ‘home’ that is general practice.

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1. Simon Gibbs
  
  June 11, 2015 at 9:22 pm
  
  A Classical Liberal is a type of libertarian, at least when the word appears next to “home”.
  
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