All posts by stephanie degiorgio

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.

Resilient GP Response to the Hunt “New Deal”

GP s across the country have been awaiting the “New Deal” with bated breath…….and scepticism.

One of the most uttered responses?  “Will this be the thing that finally makes me emigrate?”

Well, very possibly. Why?

Because it is a masterpiece in obfuscation and demonstrates the Secretary of State’s mission to ignore the blindingly obvious and push his own agenda against a growing wealth of evidence that it is wrong.

GP s are working hard, we are working at the edge of safety and the 2.5K GPs who are part of the Resilient GP on-line group speak of feeling undervalued, over-worked,  at constant risk of complaints from an ever more demanding public and picking up the pieces of hospital care being “transferred ” to the community. How is he going to fix this with this “new deal”?

  1. He is going to give us data on staffing levels. Oh good, we often wake up at night worried about needing more data.
  1. He is offering GP trainees an extra year IN HOSPITAL training posts.

 An extra year in GP placements would be great. It would help people to pass exams first time which would improve morale as a result and enable GP s to hit the ground running when they qualify. The RCGP and those doing the training on the ground have wanted this for a while, but Mr Hunt has increased the length of hospital training, for GPs.

  1. He wants us to work 7 days per week. This is despite growing evidence that 7 day working isn’t necessary. Many areas are ending their Sunday surgeries due to lack of demand. The complex elderly patients need and value continuity of care, 7 day opening will spread us more thinly during the week. This is precisely what will damage their care.
  1. He is going to give us 10,000 more primary care staff. Presumably they are currently growing on the same tree as the 5000 GP s he has been promising for ages. GP practices wont be able to afford to employ them currently without more funding, even if they did exist.

Our response to Mr Hunt then……….So far Mr Hunt, your New Deal isn’t really cutting it.

We like the efforts to encourage new doctors to join General Practice and helping people return to work is great, please make that happen FAST.

What would we have liked to have heard you say?

  1. Encourage the public to use General Practice responsibly.

You understand and value the good value care we provide. Therefore, you will stop denigrating us in the press and encourage the public to value us and use our services in a wise and sensible way. In fact, you will start some public information campaigns to ensure people understand the cost of the service and what it is reasonable to ask the NHS and GP s to do.

  1. Increase the global sum

General Practitioners are very good at spending money efficiently for the good of their patients. Therefore, you will stop incentivising us to work through dozens of piecemeal programmes that often require more administration time and data             collection than their improvement of patient care could ever hope to achieve, You  will, instead, increase the global sum and allow us to set up high quality services that   work well for our individual patient populations.

  1. Giving GP s funded headspace

You understand that GP s are being asked to commission and design new services and work differently. The recent Nuffield Trust report said one of the biggest barriers to this is the huge clinical workload preventing GP s from being able to take time for this. So agree for funded time for us to meet and plan, getting good quality locum cover for our patients. There could be one problem with this plan however, despite more people becoming locums, it is hard to get one.

  1. Reduce the bureaucracy

CQC visit preparation, constant data feedback to NHSE local teams to justify payments for schemes, poorly thought out schemes like the unplanned admission programme…..all of these take hours of time for ourselves and our admin team. Time we could be spent caring for patients or planning new services. Listen to us and take the time to get NHSE, HEE and CQC to massively reduce the bureaucratic burden they place on practices.

This New Deal, may well turn out to be the final deal for some GP s who now decide to retire or emigrate as there has been nothing new offered. What a wasted opportunity.

We will continue to support each other and aim to protect the future of high quality general practice.

But we won’t sit back and let you desecrate one of the best primary care systems in the world due to ignorance of what we do and how we do it. Rearranging the deck chairs is getting us nowhere Mr Hunt.