Saturday, December 13, 2014

General Practice..beyond the anger? Part 1

GPs are least on social media they are.Look at twitter or any social media for that matter, apart from anything else, any suggestions to even do something, have a debate about anything different descends pretty much within 3-4 minutes to total a pack, you get absolutely overwhelmed by someone "out of touch", someone "who misses the point", someone being "protective about their patch"...140 characters condenses strong emotions into what appears to be rude, recalcitrant and disengaged. But hey, its always worth a discussion because lets be honest, its not working, is it? The dangled carrot of more GPs seems more like hunting for the El Dorado gold- while the reality on the ground is that most trainees are not picking this specialty, many do NOT want to be partners...a reality check is always important and no, you can't force anyone to be a GP.

It must be said however that there is a difference with people I meet day in, day out though. I interact with GPs every day- all across 80 surgeries or more- and rarely if ever I see angry folks. In the main, they are pleasant, keen to help- yes, tired, brow beaten, aware of increased pressures but importantly very appreciative that they aren't the only ones. The british sense of humour is ever present- and I do enjoy a lot my time spent with them...maybe twitter is skewed. The issue however is that this isn't a complete rarity. The system now has ground all into such a corner that now you have what one could describe as trench mentality. Yes, I am a Consultant in Diabetes but I have been fortunate enough to hold different roles in community beyond diabetes, within hospitals in unscheduled care to understand that there are many-, many others who are as busy as anyone else. District Nurses, Community nurses, ED doctors, MAU their feet, busy, horrendously busy, tired faces- and if I am being brutally honest? As I have said before, yes GPs are busy but so are plenty others- its not a monopoly on the level of busy-ness neither is there a prize or competition out there to win. The system is squeezed, money is short, politics is huge- we are ALL under pressure.
There are 2 views at looking at this- and let me make this clear- these are views from GP colleagues themselves- NOT from ivory towered specialists or managers or anyone who has no experience of General Practice. View A is that people are well paid on a public tax funded structure, amongst the top 5-10% of the whole population, armed with a pension scheme which is gilt edged and now that the pressure is on, there are too many complaints. Be grateful for what you have, do the hard yard, earn your pennies and retire happily. Do the job you trained to do- and accept public srutiny is more- and get on with it. View B is its all too much- work has descended on GPs without agreement, without resources, public expectation has been fuelled and its time to take a stand and say "Enough". Time to stop doing X, Y and Z.

My view? Either views are too entrenched. I will be perfectly honest- if you want more people to join GP land while at the same time, you consistently say its too much- you forget the basic psychology of the generation we live in. This is no longer the Baby-Boomers or Generation X who would grit their teeth and do it in times of pressure- the next generation is a mixture of Generation Y and Generation "Me". We can critiicise that as much as we want but for that generation, work life balance is extremely important. I know lot of people turn their nose up at it- but I never ever fault anyone for that. THAT'S the world we live in- THAT'S what we have to work with- so if you want to attract more to a specialty- you must balance out your views- YES absolutely make it clear its hard, tough- but also show how amazing GP life can be- how rewarding it can be- how much work life balanace there can be...its can't be all bad, can it? Your present angst at the system shouldn't result in the future being bust, should it? And let's be honest, if GP surgeries collapse, thats pretty much the end of our beloved "free for all" NHS.

So...apart from the nebulous Narnia-esque idea of "more GPs" there actually any solution to the crisis looming? The future path for the NHS has been outlined in the Stevens report...does any of the clues lie there? More importantly, is there an appetite for this amongst GPs? Can they genuinely be in charge and think beyond their individual surgeries? In my next blog, I will throw open some questions ...

Finally,those who feel strongly against any of the thoughts above or in next blog, my appeal..have a proper debate, not a condensed angry one in 140 characters...but let me be perfectly honest, more GPs isn't going to solve the NHS conundrum- and will only act as yet another finger in the dyke.

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