GPs are at “breaking point” and in need of respite, leaders warn
Dear Editor
On 8 May 2021 Gareth Iacobucci reported in The BMJ that ‘GPs are at “breaking point” because of the “intense” workload facing doctors and staff.’
I am a recently retired GP and this headline made me feel uncomfortable. I joined the medical profession 40 years ago for the usual good reasons. I think I said at my interview that I wanted to do some good in the world. Now, as a youthful 61 year old I feel guilty that those who were so recently colleagues are struggling with this overwork, and those who were so recently patients are not receiving the care they need. I would happily do a few sessions a week to help out, as would many in my situation.
Why do I feel that the door slammed behind me so forcefully on my last day at work?
There are many reasons!
Firstly, the modern bureaucratic demands to remain fit to practise. During my last decade at work the whole business of GP Appraisal and ‘continuing professional development’ became miserably overwhelming.
Secondly, the expense of maintaining all these proofs of ‘competence’, GMC registration, as well as the soaring cost of medical litigation insurance. 10,000 recently retired GPs doing one session each per week would make a significant contribution, but individually they would barely break even against these unavoidable expenses.
Thirdly, I am daunted by the increasing complexity of modern clinical IT. Most doctors in my situation were trailblazers in the use of computers in primary care and were fully conversant with sophisticated systems – don’t condemn us as dinosaurs in this regard. However, nowadays there is so much ‘bolted on’ to the basic systems. It’s often impossible to access hospital letters, lab results, and other HCPs’ opinions other than through IT. To see patients safely at ten-minute intervals the modern GP needs to manipulate these IT systems seamlessly and at speed.
Fourthly, any self-critical, reflective practitioner begins to lose confidence towards the end of a long career. The voices of doubt become more clamorous: “Am I still up-to-date?”, “Can I still get my head around some of the new ideas and concepts?”, “Am I still credible whilst peering over my spectacles with white hairs growing out of my ears? More than ever before we need to be gently re-introduced and nurtured within a supportive team. However, practically the only option open to us, becoming a locum, is the antithesis of this. Locums continue to be treated appallingly – expected to turn up, often without even a welcome smile from an established team member, and field a full surgery of patients they have never met before, at the still-standard rate of 10-minute appointments, often struggling with an unfamiliar IT system. All of this is, frankly, terrifying for an older doctor.
The answer to this might be some form of supervised practice as I advocated, along with three colleagues, in 2016, in a BJGP article: ‘The Roundhouse: an alternative model for primary care.’1
Surely my 35 years of experience cannot be valueless? However, if NHS primary care wants my help, it needs to meet me halfway.
1. Lewis DM, Naidoo C, Perry J, Watkins J. The Roundhouse: an alternative model for primary care. Br J Gen Practice 2016; DOI: https://doi.org.10.3399/bjgp16X685129.
Rapid Response:
GPs are at “breaking point” and in need of respite, leaders warn
Dear Editor
On 8 May 2021 Gareth Iacobucci reported in The BMJ that ‘GPs are at “breaking point” because of the “intense” workload facing doctors and staff.’
I am a recently retired GP and this headline made me feel uncomfortable. I joined the medical profession 40 years ago for the usual good reasons. I think I said at my interview that I wanted to do some good in the world. Now, as a youthful 61 year old I feel guilty that those who were so recently colleagues are struggling with this overwork, and those who were so recently patients are not receiving the care they need. I would happily do a few sessions a week to help out, as would many in my situation.
Why do I feel that the door slammed behind me so forcefully on my last day at work?
There are many reasons!
Firstly, the modern bureaucratic demands to remain fit to practise. During my last decade at work the whole business of GP Appraisal and ‘continuing professional development’ became miserably overwhelming.
Secondly, the expense of maintaining all these proofs of ‘competence’, GMC registration, as well as the soaring cost of medical litigation insurance. 10,000 recently retired GPs doing one session each per week would make a significant contribution, but individually they would barely break even against these unavoidable expenses.
Thirdly, I am daunted by the increasing complexity of modern clinical IT. Most doctors in my situation were trailblazers in the use of computers in primary care and were fully conversant with sophisticated systems – don’t condemn us as dinosaurs in this regard. However, nowadays there is so much ‘bolted on’ to the basic systems. It’s often impossible to access hospital letters, lab results, and other HCPs’ opinions other than through IT. To see patients safely at ten-minute intervals the modern GP needs to manipulate these IT systems seamlessly and at speed.
Fourthly, any self-critical, reflective practitioner begins to lose confidence towards the end of a long career. The voices of doubt become more clamorous: “Am I still up-to-date?”, “Can I still get my head around some of the new ideas and concepts?”, “Am I still credible whilst peering over my spectacles with white hairs growing out of my ears? More than ever before we need to be gently re-introduced and nurtured within a supportive team. However, practically the only option open to us, becoming a locum, is the antithesis of this. Locums continue to be treated appallingly – expected to turn up, often without even a welcome smile from an established team member, and field a full surgery of patients they have never met before, at the still-standard rate of 10-minute appointments, often struggling with an unfamiliar IT system. All of this is, frankly, terrifying for an older doctor.
The answer to this might be some form of supervised practice as I advocated, along with three colleagues, in 2016, in a BJGP article: ‘The Roundhouse: an alternative model for primary care.’1
Surely my 35 years of experience cannot be valueless? However, if NHS primary care wants my help, it needs to meet me halfway.
1. Lewis DM, Naidoo C, Perry J, Watkins J. The Roundhouse: an alternative model for primary care. Br J Gen Practice 2016; DOI: https://doi.org.10.3399/bjgp16X685129.
Competing interests: No competing interests