Once upon a time there were three General Practitioners Gruff. They all worked together in a pleasant little practice situated on the side of a valley. Every day they worked hard trying to meet the needs of an increasingly demanding practice population with their ever more complex medical problems and every evening, when all the patients had been seen, the last blood tests filed and the final medical reports completed, they would stand together outside their own medical centre and gaze across the valley to the hillside opposite and imagine how much greener the grass must be at the practice that was located there.
One day, after a particularly stressful on call day which had seen him deal with so many sick and anxious individuals that he felt he could no longer continue the way he was, the youngest of the the three partners decided to move to the neighbouring practice.
But no sooner had he started to make his way across the old wooden bridge that spanned the river that separated the two health centres, than an ugly old troll appeared in the water beneath him.
‘Who’s that trip trapping over my bridge’, said the troll as he hauled himself on to the bridge to block the young GPs path,
‘I’m a GP who has not long ago started as a partner and I’m off to join the practice on the other side of this bridge.’
‘What’ asked the troll menacingly, ‘and abandon all those patients at your current practice? Have you no compassion? Is it perhaps because you know how badly you’ve managed those you have seen, how far short you’ve fallen from treating them in strict accordance with the latest NICE guidelines. Turn back at once and carry out a detailed review of every consultation you’ve carried out these past six months.’
And with that the young GP returned from whence he’d come and the very next day, so overwhelmed by the anxiety he experienced at perhaps not having done as good a job as he felt he ought to have, he began a period of extended sick leave due to work related stress.
A week later, having been unable to find a locum to cover for her absent younger colleague, the second General Practitioner Gruff decided to try her luck at the practice on the other side of the valley.
But no sooner had she started to make her way across the old wooden bridge than the ugly old troll once again emerged from the river beneath.
‘Who’s that trip trapping over my bridge’, said the troll as he clambered again onto the bridge and proceeded once more to block the path of anyone wishing to cross it.
‘I am a GP who is mid-way through my career and I’m off to join the practice on the other side of this bridge’
‘What’, growled the troll once more, ‘and renege on your responsibility to undertake an extended hours session this evening? And don’t forget you’ve promised to review your prescribing habits in for the medicine management advisor, not to mention the fact that the CQC could schedule a visit at any time and you’re far from sure that your protocol for the safe overnight storage of prescription pads is up to date.’
And with that, the middle aged GP forlornly returned from whence she’d come. Feeling completely bogged down by all the red tape that was now associated with her work, she decided to go part time and so, at the earliest opportunity, she happily took a drop in pay and reduced the number of days she worked each week.
A month later, and with no cover for either his colleague who had reduced her hours or his junior partner who was still off sick, the third General Practitioner Gruff made his way to the old wooden bridge that crossed the river at the bottom of the valley.
But once again, no sooner had he started to make his way across, than the ugly old troll made yet another unwelcome appearance.
‘Who’s that trip trapping over my bridge’, said the troll as he dragged himself out of the water and took up a position that barred the way forward of the one approaching.
‘I’m a GP approaching the end of my career and I’m considering my options’, said the oldest General Practitioner Gruff.
‘Considering your options eh’, snarled the troll as he himself considered what options he might have to dissuade this latest visitor from continuing on their journey. But before any words came to the hideous creatures mind, the GP himself had some things to say.
‘I’ve been a GP now long enough to realise’, the last of the General Practitioners Gruff began, ‘that being made to feel guilty for things I can’t control is not fair. There is no shame in being asked to do more than one is capable of and only being able to do what one can. And, as well as much of what we are now asked to do having absolutely no value, too much of what we do that is important can’t be done properly on account of how little time we have to do it.’
‘So you’re off to join the practice on the other side of this river because you think things will be better there I suppose’, sneered the troll.
‘On the contrary’, replied the oldest General Practitioner Gruff. ‘Things will be no better there than they are at my current practice, they may even be worse. Rather, because the job has become so intolerable, and because older GPs are not being encouraged to remain in practice by a system that seems set on destroying what once was considered the jewel in the crown of the NHS, I, like many of my older colleagues, am heading off to find something genuinely worthwhile that I can spend my few remaining years trying to do well’.
And with that the oldest General Practitioner Gruff ran towards the troll and, swinging the latest missive form NHS England like a cricket bat, struck the troll smack between the eyes sending him soaring into the sky until he finally disappeared from view beyond the brow of the hill on the far side of the valley.
And then, with the trolls jibes never to be heard again, the oldest General Practitioner Gruff continued on his way, across the bridge, past the neighbouring practice (which had in fact been forced to close down for want of staff) and on into early retirement where he lived happily ever after, until of course he became ill himself and there was no NHS left to treat him and a complete lack of social care to look after him.
Because not every story can have a happy ending.
Sadly, this is no fairy tale. According to The Health Foundation REAL Centre, the NHS in England is facing a crippling shortage of GPs and general practice nurses over the coming decade with projections showing that the shortage of qualified, permanent GPs is set to get substantially worse over this decade.
There is currently a shortage of around 4,200 full-time equivalent [FTE] GPs, which is projected to rise to around 8,900 FTE GPs in 2030/31, relative to the number needed to meet the rising need for care. This means that without a change to current workforce trends and policies, close to 1 in 4 of the 37,800 general practitioner posts needed to deliver pre-pandemic standards of care would be vacant.
However, if an increasing number of GPs leave the profession due to burnout and if newer roles are not successfully integrated in multidisciplinary general practice teams, the projected shortfall could increase to 18,900 FTE GPs, or around half of posts being vacant, in 2030/31.
To read some more unlikely stories:
To read ‘The Three Little GPs and the Big Bad Secretary of State for Health’, click here
To read ‘Mr Benn – the GP’, click here
To read ‘A GP called Paddington’, click here
To read ‘Scooby Doo and the Deserted Medical Centre’, click here
To read ‘Dr Jonathan Harker and the post evening surgery home visit’, click here
To read ‘Bagpuss and the NHS’, click here
To read ‘A Dream of an Antiques Roadshow’, click here
To read ‘The NHS Emporium’, click here
To read ‘Mr McGregor’s Revenge – A Tale of Peter Rabbit’, click here
To read ‘Jeepy Leepy and the NHS’, click here
To read ‘Dr Wordle and the Mystery Diagnosis’, click here
To read ‘The Happy Practice – A Cautionary Tale’, click here
To read ‘The Scrooge Chronicles’, click here
To read ‘Jeeves and the Hormone Deficiency’, click here
To read ‘General Practices are Go!’, click here
To read ‘A Mission Impossible’, click here
To read ‘A Grimm Tale’, click here
To read ‘The General Practitioner – Endangered’, click here
To read ‘The State of Disrepair Shop’, click here
Some musings 
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