Monthly Archives: July 2015

We really must meet again Mr Hunt

Dear Mr Hunt

Eight months have passed since I challenged you at the RCGP conference in Liverpool and I think we still have some unfinished business. The elephant in the room is now a stampede.

In the time that has passed between then and now, it has become increasingly unpleasant to work as a GP in the UK. This is a real shame; General Practice used to be a really fulfilling job, and on some days, it still is. The majority of my patients are wonderful and providing them with high quality professional medical care is incredibly satisfying. I love that part of my job; I know that I make a very positive difference to the lives of many people.

So, what’s the problem you may ask?

When did you last visit a GP Mr Hunt, as last time your kids were ill you bypassed the system and took them to A&E. Perhaps this was a publicity stunt to prove a point. The reason I ask is that I and many others have realised that you have absolutely no idea what a GP actually does. I don’t say this lightly, I know you aren’t a stupid man, but the fact that you think that we can be replaced by physicians assistants who will have done a maximum of 82 days training in general practice as part of a 2 year postgraduate course and who even then will be unable to write a prescription makes me wonder?

Becoming a GP is the end result of a minimum of 10 years of training. I use every year of that experience to do my job properly. We see people who may have something serious or who may have something minor, but both presenting with the same symptom. Deducing the cause takes knowledge, skill, time and experience, not a computer algorithm. I spent 6 years teaching people how to be GPs too. I have seen very capable clinicians fail at becoming a GP because it requires a very precise and highly tuned set of skills, both clinical and communication based. This simply cannot be achieved in a shorter amount of time, in fact, it probably needs longer training based in General Practice, not in hospital.

Instead of valuing this professional expertise, you currently seem hellbent on denigrating it. Not all GPs are going to be perfect, we know that, we are human, but every negative headline suggesting that we don’t know what we are doing, or that we earn too much, or that we don’t work hard enough or don’t diagnose enough of this or that, eats away at public confidence in us and makes patients distrust us. This is leading in turn to an increased number of complaints (in fact, the GMC and ombudsman are encouraging people to complain). This causes a further loss of morale and wastes an inordinate time to answer. Some complaints are justified, sadly more and more are about patients not getting what they want, rather than what they need. This is fuelled by your consumerist approach to the health service.

What on earth you are you up to? There is now a petition with more than 100,000 people calling for your resignation. You are attacking consultants, GPs, in fact anyone involved in the delivery of the health service (with the notable exception of your pal Simon Stevens at NHS England). One must ask oneself why. My guess is that it is a well considered plan to set the medical profession up as the scapegoats for the NHS collapsing. You have absolutely no intention of helping it survive. This clearly cannot be seen to be your fault though; that doesn’t make good politics, so why not make it the fault of the GPs trying to run commissioning groups, the consultants or GPs who won’t work 7 days routinely. We aren’t stupid either Mr Hunt. If you were to resign, someone else would simply step in and do exactly what you are doing, because this is the policy your government has decided to implement.

Whilst I am a GP, I have worked in hospitals too. I have trained GPs (I resigned because the evil cousin of NHSE, HEE made that job too unpleasant to do too), I work for the local CCG and I am a GP appraiser. I have 2 young children. It would be easier for me not to care about all of this and just plod on and do my job. But I can’t because your actions have made my job almost unbearable. I have the CQC, the GMC, NHSE and the ombusdman all waiting for me to make a mistake and pounce. I have patients coming in ready for a fight because you have raised their expectations and they think I am basically an antibiotic dispensing machine who earns too much and they know better than me (some do, I am not that arrogant).

I have watched colleagues flounder and indeed I have had to take time off due to the anxiety all of the above creates.

With lovely colleagues around the country we set up ResilientGP to try to educate GPs in sustainable ways of practicing that will enable them to not burn out and to support each other. We have 2726 members as of today and running that forum means we see and hear about the daily struggles and thoughts of those who post. They are frustrated, fed up and many are planning their emigration or retirement as I write this.

Why does this matter? It matters because without good quality primary care the population of the UK will suffer. At the moment, thanks to your rhetoric, they don’t really know this. They don’t appreciate that their surgery is probably only one retirement away from shutting, they don’t really understand that the shortage of GPs in the country means that they may not have one soon. This is the inconvenient truth and so instead of having a grown up discussion with the population about using the NHS in a responsible way, you instead make us out to be the incompetent baddies.

I could emigrate. My husband is a GP as well and we could be financially better off and probably happier in another country, but we aren’t, because I want to stay here and look after my patients and help General Practice in the UK to survive.

We know what you are up to, we know why you are doing it. We ask that your party stops and has a sensible discussion with the professionals who know what is happening at the coalface (not some of the yes men/women who you use to give credence to claims you have consulted the profession). There are ways of fixing this. Lets discuss them.

You were too busy to visit a GP practice who invited you to spend some time with them “due to prior commitments” until September. May I politely suggest Mr Hunt, that you and your ill-advised staff shift your priorities and in your words “get real” about the perfect storm you are currently overseeing.

“It’s not our fault, those nasty GPs made us do it!”

“Morning, how are you? So you’re struggling with your knee? Ok, let’s take a look, pop up on the couch.

Right, what I suggest for the time being is some anti-inflammatories and gentle exercise. It’s better to avoid those drill wielding hospital doctors for as long as possible. It’s a bit of a slippery slope once you embark on the surgical route. Let’s see if time and patience will do the trick.

Hello again, no better? Physiotherapy for you then I think. They can work wonders.

Still no better? Righto, let’s get an X-ray sorted and we’ll get you off to the orthopaedic guys, to see if they can help. There are a number of possibilities and treatment options depending on X-ray and scan results, let’s see what they say.”

So, this is option one. This is what goes on in every GP surgery, every week of the year, but let’s take a look at the parallel universe of the British Orthopaedic Association.

“Morning, how are you? So you’re struggling with your knee? Ok, let’s get an MRI and ask the orthopaedic surgeons to see you.

REALLY??? Are you serious?

General Practice and Practitioners are becoming inured to the constant barrage of abuse and approbation from politicians and the media, but there is a particularly offensive sting to ill-considered criticism from colleagues, who frankly should know better than to throw stones in their secondary care glasshouses.

The phrase, “…….if GPs are doing their job properly….” has a wonderfully arrogant and patronising ring to it don’t you think? And as for, “………performance of this investigation (MRI) replaces the traditional medical skills of history taking and physical examination of the patient…”, well frankly, words fail me.

General Practice effectively manages the vast proportion of clinical presentations without the need to refer to secondary care. Those that are referred are done because further management is beyond the clinical expertise of the referrer, hence transition to the supposed ‘specialist’.

But it appears not. Orthopaedic surgeons are apparently incapable of utilising “the traditional medical skills of history taking and physical examination of the patient”. Nor are they able to deal effectively with patient expectation. No, instead it appears it’s the GPs fault for not managing the patients properly in the first place.

If we listen carefully outside the orthopaedic clinics, we will hear the bleating cries of the poor little lambs, “we didn’t want to do an arthroscopy, those nasty GPs made us do it.”