What should GPs stop doing?BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4976 (Published 27 November 2018) Cite this as: BMJ 2018;363:k4976
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Helen Salisbury is correct to say we are undeservedly suffering the consequences of the government’s poor human resource planning. Importantly, we have been given no support in return for this oversight. In fact, the reverse is true: in addition to an increased workload, when practices can no longer cope without crucial GP replacements, they are forced to merge or collapse. This is invariably accompanied by suggestions of incompetence - unfortunately including from colleagues. These episodes are both distressing and hugely expensive - to individual doctors as well as the tax payer.
We are the most trusted professionals in the country and have great potential to raise public support to end this woeful situation. However, until we find enough charisma amongst our leadership and solidarity amongst ourselves, colleagues will continue unfairly to suffer.
Competing interests: No competing interests
I agree that being a good parent or physician is not about being present only for the special moments.<1> Nevertheless, you are not bad parents if you carefully delegate duties to family members and daycare staff. If parents try to do everything themselves that results in burnout and suboptimal care of their children, are they good parents?
I hear concerns on limited resources to hire more assistants, or more politically correct, non-medical partners. It certainly does not help receiving public funding when physicians constantly argue against expanded practice of other health professionals.<2><3><4><5> Some physicians may fear their positions being replaced by “doctors-on-the-cheap,”<6> and advocate funding to be allocated to GP recruitment instead. However, would GPs become more easily replaceable with a surplus of GPs on the market? Would we have more unhappy GPs, swamped with administrative work not representative of their true abilities?
Like many, I heard of denigration of GPs.<7> Moreover, I heard of mockery on the ease of GP trainee selection process. If we desperately recruit to simply meet the target of 5000 extra GPs by 2020, the quality of our recruits would be inevitably affected. Would the prestige of GPs be any better?
I understand that minor illness could be entangled with serious consequences,<1> if the wrong diagnosis is made. Similarly, I believe making diagnoses and management plans are still the bread-and-butter of physicians. However, after a diagnosis is made, should some of the work be delegated to other health professionals? For instance, clinical pharmacists are licensed professionals capable of monitoring drug therapies and assessing adverse drug reactions.<8><9> I hear naysayers’ concerns about interruptions and miscommunication with other health professionals’ involvement.<3><4><6> But these are modifiable teamwork skills which physicians and others alike could continually work on. Is it not better uses of resource and physicians’ abilities to see more new patients, rather than mundane exercises which others are also capable of?
1. Salisbury H. What should GPs stop doing? BMJ. 2018;363:k4976.
2. Rimmer A. Medical associate professions: how physician associate and similar roles are developing, and what that means for doctors. BMJ. 2018;362:k3897.
3. de Lusignan S, Hoghton M, Rafi I. Flu vaccination by pharmacists leads to suboptimal medical records. BMJ. 2017;359:j5084.
4. Lynes S. Multidisciplinary care. Br J Gen Pract. 2017;67(661):348-348.
5. Avery AJ. Pharmacists working in general practice: can they help tackle the current workload crisis? Br J Gen Pract. 2017;67(662):390-391.
6. McCartney M. Margaret McCartney: Are physician associates just “doctors on the cheap”? BMJ. 2017;359:j5022.
7. Iacobucci G. Medical school “banter” denigrating GPs and psychiatrists must stop, say college heads. BMJ. 2016;354:i5316.
8. Yeung EY, Mohammed RS. What tasks can physicians delegate to pharmacists? Br J Gen Pract. 2018;68(676):519-519.
9. Yeung EYH. Adverse drug reactions: a potential role for pharmacists. Br J Gen Pract. 2015;65(639):511.
Competing interests: I have been paid for working as physician and pharmacist, but not for writing this letter.