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Rapid Responses: Rapid Responses published:
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Unfairness and early experience
- Jenny Firth-Cozens (15 August 2004)
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The grass is always greener.
- Dr Richard L Davies (17 August 2004)
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Sharing Workload in Group Practices
- Andy Stewart (18 August 2004)
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astonishing
- ruth l evans (21 August 2004)
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Jenny Firth-Cozens, Consultant Psychologist Hillside, Garth Row, Kendal LA8 9AT
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It was interesting to see that perceived inequality remains an issue for general practitioners. Some years ago when I was conducting a follow- up of my 1983 cohort I found that depression in senior general practitioners was best predicted by perceived envious sibling relationships when young [1], as measured when they were students. Strangely, almost all had siblings. This suggested to me that perhaps one reason that doctors enter the family milieu of general practice is to recreate earlier family life, the good or the bad. Those with a poor early experience may perceive the inevitable inequalities of working life rather faster and more negatively than others. If such a finding held good in other studies, then it may be quite difficult to “cure” the current workplace problem in any simple manner. Firth-Cozens, J. Individual and organizational predictors of depression in general practitioners. British Journal of General Practice, 1998; 48: 1647-1651 Competing interests: None declared |
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Dr Richard L Davies, GP Partner 703 Leeds and Bradford Road, Stanningley, Pudsey, LS28 6PE
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It is part of human nature to think the grass is greener on the other side. Sometimes it is and sometimes it isn't but in the complex work of general practice I remember a remark made by an experienced collegue " If you don't think you are working harder than your partners then you're not working hard enough " Competing interests: None declared |
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Andy Stewart, General Practitioner Health Centre,Gunnislake,Cornwall PL126RX
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Editor-in their article(BMJ August 14th) Branson and Armstrong gave considerable food for thought in their exploration of GPs' beliefs about equitable sharing of workload between partners. We have a 13 doctor partnership with a healthy mix of full-timers,part-timers and jobsharers. The potentially thorny issue of who might not be doing their fair share of our considerable workload is not an issue for us as we work with strict personal lists. This has several advantages.Firstly we all have the same potential workload and if some of us are less efficient at managing it there is no spill over onto other colleagues.We are very motivated as a group to look at ways of working more efficiently as if we don't it is ourselves who will be inconvenienced rather than our partners.It is also easier to spot sooner a colleague who is underperfoming due to stress or illness and to intervene supportively than would be possible in a less structured environment. A personal list system means having a clearly identified physician of prime concern who has the responsibility of ensuring that each patient is "sorted out" by one doctor rather than being passed around like a baton in a dysfunctional relay race with the assumption that somebody else will be the one crossing the finishing line.It also enables clinical governance issues to be more easily addressed with the audit trail being very much easier to follow if we want to find out who has done what to whom and why. Knowing your patients well saves a lot of time in consultations and also when electronically accessing pathology results.When there is a bereavement it is far easier for both the family and the doctor to engage in counselling and support than it would be in a practice of the same size without personal lists. Finally,it is my experience from being involved in cause for concern procedures both nationally and locally that patients are less likley to lodge a complaint against a GP with whom thay have a longstanding doctor-patient relationship than with one they have only seen a handful of times. Of course no system must be so rigid that it fractures. Team working is vital in a personal list system, not least to ensure that partners do not become isolated. We all have holidays,study leave,sabbatticals,half- days and periods of illness when we are not able to attend to our own patients, and on these occassions they will be seen by a colleague. There has already been a significant dilution of personal lists with the coming of out of hours organisations, job-sharing arrangements,increasing use of locums,and nurse practitioners. Many feel that the personal list system is an anachronism from a bygone Finlayesque age.On the contrary,it is the formula which if properly appled could ensure that we in General Practice continue to deliver personalised continuity of high quality care. That way lies job satisfaction, happy patients and an absence of feelings of resentment between partners about the sharing of workload. Of course this may not be what the politicans want in an age of drop in centres,one stop shops,advanced access, star systems and league tables. However, if we are to attract into the NHS and equally importantly retain a new generation of family doctors then job satisfaction must assume the highest priority. The chaos of non-personalised care in an increasingly demanding and impersonal Health Service cannot gurantee that. Dr Andy Stewart
Competing interests: None declared |
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ruth l evans, GP Wallsend, ne7 7nb
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I suppose it should not be surprising that gripes about workload are so common. This very helpful article brings it all out into the open- which is potentially the first step to sorting it out. What can be done? Who can do it? Importantly, as most GPs are independant practitioners, who will pay for it to be done? The next piece of work would be to implement some changes and then evaluate effectiveness. I cannot wait! Competing interests: None declared |
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