How GP practice has got to this point, and the possible solutions
Dr Christopher Hopkins
- Credit: Sarah Lucy Brown
I resigned from my National Health Service practice in 1990 in protest against the government imposing its own regulations at that time. It is this that has changed the nature of general practice since with protocols and targets that now result in form filling that can take two hours everyday.
This has steadily increased over the years. Previous to this practitioners were entirely independent contractors who managed their practices in the best way they felt with attention to patient's needs rather than meaningless bureaucracy.
An American at that time sneeringly described it to me as socialised medicine. I said nothing could be further from the truth. We were paid by the government but after that we had no interference.
Apart from these contracts the most fundamental change in general practice took place in 2004, when under the Blair government, practitioners were no longer obliged to give patient care out of daily working hours i.e. at night and weekends.
This completely changed the ethos of practice. From the feeling of having total care and responsibility it became more of a 9-5 job (in reality 8-6.30pm)
To add to this another change took place around the same time. Home visits became less and less frequent. It is seeing a patient in their own home often with the family around that especially developed that bond and friendship which is more difficult to establish without.
If I meet up with former patients now who are difficult to remember I always ask where they lived. In the same way social visiting of the elderly has become a relic of the past, a much loved and appreciated contact.
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So what has changed in the surgery itself? It has become more intense. With computerisation resulting in instant return of blood reports and letters from consultants everything goes at a faster pace. With greater longevity there are many more elderly patients with chronic illness.
There is a greater demand and expectancy from patients who are now enlightening themselves from Doctor Google. There is more fear of litigation in a blame culture age.
Doctors are expected to be super-men and women and medicine infallible. With the vast amount of paperwork as already mentioned doctors feel more pressurised. All this results in there being no time now for any but essential visits and certainly not social ones.
This pressure of work has resulted in more and more doctors being unwilling to work full time in general practice (which for a GP equates to a 50-60hr working week) both those in harness reducing their days and the newly qualified starting up.
A recent survey suggested only 18% of newly qualified doctors wanted to work traditionally full time and would rather split their time with working in other areas of medicine education and training. To exacerbate the shortage a larger percentage of qualified doctors are women. Quite sensibly when they have families they only want to work part time.
This results in a vicious circle. The few remaining full time doctors, being under greater and greater pressure of work, looking after more and more patients, makes it less attractive for new doctors to join them.
As a result general practitioners have complained about feeling more stressed. For an old timer like myself in their 95th year this can appear difficult to understand, when we compare it with our own times.
Then we could be on call night and weekends and called to any emergency including accidents. It was a question of doctors first and ambulances second with no paramedics to help. This was particularly stressful if called out in surgery time. On occasion this meant accompanying a patient to hospital.
Meeting a former patient recently I was reminded of this, going in the ambulance with his mother to Ipswich. In contrast, today GPs only occasionally attend emergencies. The patient or surgery phone for an ambulance and or paramedics.
A continuous daily stress was getting round all the visits and branch surgeries (now no longer) in time for the evening surgery.
Retired now 31 years, I still have nightmares about getting round in time. But there was no actual mention of stress in those days.
So what is the difference? Was there a different breed in the past? It is hard to say. I think morale has a big part in it. If you are happy and fulfilled you can override traumatic and stressful events.
You were your own person then, particularly proud to be part of a noble profession, looked up to by all around. This is more difficult to feel now when continually directed by a higher authority.
So what can be done? Firstly, bring back pride in the profession by making it more independent. Secondly, attract more full time practitioners to lessen the load.
One simple solution would be to recognise the trends in more doctors wanting to work part time, and hence train more doctors. Thirdly reduce the bureaucratic burden of yearly appraisals, five year revalidation, CQC inspections and numerous other tick-boxing exercises which reduce the time for direct patient care.
- Dr Christopher Hopkins was a GP in Southwold, and has written a book about his career.