Over the last year, General Practice workload has increased to levels which are unmanageable, unsustainable and, on occasions, undoubtedly unsafe. Why is this? The reasons are undoubtedly many and varied but they do at least include the following.
1. The effects of Covid 19. Whilst a few patients continue to attend with delayed presentations of conditions that should have been dealt with a couple of years ago, far more significant is the fact that the pandemic has left many on long hospital waiting lists and who, as a result, find it necessary to visit their General Practice for interim help for conditions for which they require specialist care.
2. The underfunding over successive governments of an NHS which is now, as a consequence, on its knees but which, nonetheless, continues to be expected by everyone to be there whenever it is needed and able to provide all the care that is asked of it.
3. Increased patient numbers per GP because, despite government promises to the contrary, there has been a reduction in the total number of GPs nationally. Furthermore, in some areas, the closure of GP practices has seen the subsequent reallocation, often at short notice, of patients to neighbouring practices without the necessary additional staff being made available.
4. A surge in the number of those struggling with mental health problems often as a result of the measures taken to combat Covid 19. Social isolation has taken its toll on many, not least children and young people, as too has the economic hardship which now seems only likely to increase over the next year or two.
5. A negative media which has encouraged some to think that GPs are not doing their job properly and led many to demand more of us mistakenly imagining that we have the capacity to do so when in truth we do not.
6. Having been sold the lie that life should be without suffering, there are many who are now intolerant of even the most minor of problems and insist on treatment for things that in the past people would, perhaps, have accepted and put up with for longer. Add to this the fact that, as a consequence of our living in an ‘Amazon Prime’ culture where all our desires are guaranteed to be delivered free tomorrow, many find themselves unable to wait and so insist that their treatment must be ‘now’.
7. An inability of many to tolerate any degree of anxiety with a good number of those who now present to GP practices falling into that group of patients sometimes known as ‘the worried well’.
This last group I think is huge but it is the medical profession who must take much of the responsibility for their growing number. For it is not surprising that we have the worried well when, for years, we have told the well that they should worry. Neither is it surprising, then, that we find ourselves spending inordinate amounts of time dealing with those who are not ill at all.
So what we can do about it? Many of the problems mentioned are beyond our control and though we should still petition for a better NHS, continue to hold the government to account and endeavour to engage with the media to accurately describe the current crisis that we all now find ourselves facing, we need also to a accept that we can’t single handedly change the society in which we live.
What we can do though is rediscover what it is to be good doctors. So what is it that good doctors do?
Well, for a start, they care for patients. And irrespective of how strong the temptation may sometimes be to think otherwise, they remember that the patients are NOT the enemy!
We need to take up our posts once more and act as the gatekeepers of the NHS protecting hospitals from patients but, far more importantly, protecting our patients from hospitals. We need to stop being people pleasers, something I will find particularly hard, and seek to do what is right by our patients rather than that which is popular, telling them the truth rather than what they want to hear. We need to apply a little wisdom in our consultations and avoid falling into the trap of mindlessly following protocols and merely acting according to algorithms. And, instead of adding to the anxiety of our patients, we need to be prepared to carry some of their anxiety ourselves. Because taking on that responsibility is what being professional is all about.
And finally we need to remember what good doctors DON’T do. Good doctors don’t turn away those who are sick and no doctor should feel compelled to do so. To take such an action would be to play into the media’s narrative that we are reneging on our responsibilities as GPs, it would turn our patients against us and so lose their support which is so vital to us if we are to come out of this in one piece, and it would make the already difficult working lives of our receptionist even harder. And of course, rather than being gatekeepers to the hospital, it would make us those who had abandoned our post and left the gate wide open. To do so would be to dump on our friends and colleagues in secondary care who are themselves struggling every bit as much as we are.
So in short it would sadden me hugely if we were to ever cap the number of patients who could see us on any individual day, if we were ever to become a profession which refused to see those who came to us in genuine need and thus deny them the help which was most appropriately provided for them in primary care.
And whilst appreciating the reasons for taking such drastic measures, I hope that I’m not the only one who would be at least a little embarrassed to be associated with such a move if, as some are advocating, it were to be deemed necessary. I fully understand how difficult things are at present, but alternative solutions must be found. Because to be a part of such a profession would, for me at least, only worsen the situation by making my working life even less satisfying. For there is still a joy to be had in helping others in need, a pleasure that comes, not merely from miserably doing our duty and soullessly performing what is required of us, but that comes as a consequence of our being in the privileged position of being able to make a positive difference in the lives of so many.
And that is something we dare not lose.
To read ‘On Being Overwhelmed’ click here
To read ‘Bagpuss and the NHS’, click here
To read ‘Health – it’ll be the death of us. Is there institutional arrogance in the NHS?’, click here
To read ‘The NHS – the “S’” is for “Service”, not “Slave”’, click here
To click ‘Something to reflect on’, click here
To read ‘The Repair Shop’, click here
To read ‘The Medical Condition or Hannah Arendt is completely fine’, click here
To read ‘The Abolition of General Practice’, click here
To read ‘Blaming it on the Boogie’, click here
To read ‘On being crazy busy – a ticklish problem’, click here
To read ‘Too busy to be happy’, click here
To read ‘Contactless’, click here
To read ‘From A Distance’, click here
To read ‘General Practice – a sweet sorrow’, click here
To read ‘I’ll miss this when we’re gone’, click here
To read ‘The Reintroduction of GPs Anonymous’, click here
To read ‘Mr Benn – the GP’, click here
To read ‘A Bear called Paddington’, click here
To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here
To read ‘A Mission Impossible’, click here
To read ‘A Hard Year For Us All’, click here