I’m a part time GP and full time mum to a 2 and a 3 year old. Last night the 2 year old kept me up most of the night – that’s parenthood, and I was just grateful that today was one of my days ‘off’. Since she decided to catch up on her Zzz’s in the buggy on the nursery run I decided to treat myself to a brief moment of relaxation and a pedicure.
Half way through another customer walked into the shop. A woman in her 50s, very overweight with the unmistakable growl of a heavy smoker. She wanted a mani and pedi. It’s a Friday so they are busy and explain she will have to wait. “Oh” she says, “I’ve got a GP appointment in an hour” the technician shrugs, all the staff are busy, she’ll have to come back another time. “Alright” says the customer, “I’ll get the doctor to ring me instead. I mean she rang me last night already, but it was 7.30, who wants to answer a call from the doctor at that time?”. I watched aghast as she rang the surgery and claimed she couldn’t get out the house this morning and could the doctor ring her instead.
Five minutes later I watched as she reached in her handbag for a salbutamol inhaler. “That doctor hasn’t given me the antihistamines I asked for a week ago” she told her neighbour with a put-upon sign. “Two days I’ve been without them! I can hardly breath! It’s not good enough.”
So I sat, lip firmly buttoned, I’m not in the mood for another debate, I have enough of those at work. I thought about that GP, making phone calls late into the evening. I wondered if she had worked the 12 or 13 hour day many of us now consider standard. I wondered how many patients she had seen to face that day, 30? 40? 50? How many phone calls? How many lab reports? How many letters from hospital colleagues to read and action? I wondered if she had slept well last night. Had she laid awake struggling to unwind from the stresses of the day? Did she worry that the work load meant she couldn’t do her job as well as she wanted, couldn’t do what was needed for her sickest patients? Did she fret that so many decisions made in one day made mistakes inevitable? Did she pray that she hadn’t made a mistake which harmed a patient or left her open to complaints, litigation or even criminal charges? Did she continue working at home completing a portfolio of educational ‘evidence’ to ‘prove’ she is still fit to do her job year after year? Did she see her kids that night? Did she wonder where those headlines about super-rich GPs come from when her salary seems to pay for her childcare and not a lot else? Did she wonder if her physical and mental health could survive working at this pace for the 30 odd years until retirement? I know I do.
As GPs we have become used to being undervalued by government and bashed by the press. We know the headlines about £100k salaries and 9-5 working are nonsense, we know that primary care has been chronically underfunded and over recent months we have done a better job of getting this message across. At the end of the day very few of us do this job for the money, for an easy life, or for political ambition so we often fail to be our best advocates. Most of us do the job for the patients.
The patients. ‘Think of the patients’ the juniors are told when they dare to strike over imposition of an unsafe and unfair contract. ‘Think of the patients’ GPs are told as we are asked to open our doors seven days a week despite being stretched to breaking point already.
Well sitting next to me was one of these patients. A patient who preferred to miss an appointment at the doctor than one at the spa. A patient who would happily pay £40 to get her nails done but wouldn’t dream of paying two quid for an over the counter antihistamine she was ‘entitled’ to on prescription. A patient who wants her doctor to call, but only at a time that suits HER (even though she can’t be bothered to keep her appointment). A patient who would rather have tablets and inhalers than pack in the fags to improve her own health. And perhaps worst of all, a patient who despite being called by her GP late in evening to help her with her health concerns doesn’t miss a beat in slagging off that same GP because she hasn’t got her tablets exactly when she wants them. I will accept that it unusual to witness this extreme level of selfishness and disrespect in a single patient, but I’m pretty sure that everything I have described above has been experienced by most GPs on a regular basis.
I am a fervent believer in the NHS. I consider it a privilege to work in a healthcare system that is the envy of much of the world for it’s quality and cost effectiveness. I believe in primary care as the cornerstone of our NHS. I have always argued passionately that primary care must remain free at point of delivery because, you guessed it, I’m thinking of the patients.
Today I was reminded that for too many patients a service with no charge is also perceived to have no value. Cancel your solicitor, accountant or hairdresser at short notice and expect to be charged, cancel your GP in favour of a manicure and then complain that they haven’t made you better! Ha!
All the while the GPs are seeing more patients than ever before, patients who are more complex and more demanding by the day. They are working longer hours, shouldering greater risks, earning less money and facing ever greater challenges to keep their practices afloat. In doing so these GPs are propping up a system on it’s knees. A system broken by underinvestment and constant use as a political football, and now damaged further still by a government and right wing press that stoke ever greater patient expectation and demand, whilst failing to provide the funding to meet it. It’s almost as though they want the whole thing to crumble….
Today I’m not thinking of the patients, I’m thinking of those doctors exhausted, stressed, anxious, overburdened and ploughing through the endless 10 minute consultations on this sunny day. I’m wondering how long they can keep primary care afloat for the sake of the patients. I’m wondering how long they should.
Dr Laura S