Intended for healthcare professionals

Opinion Primary Colour

Helen Salisbury: The necessity of hope

BMJ 2023; 380 doi: (Published 17 January 2023) Cite this as: BMJ 2023;380:p111
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}
    Follow Helen on Twitter: @HelenRSalisbury

January is a time for hope and resolution. Like the forward and backward facing Janus after whom the month is named, we look back to see what we can learn from the previous year’s events and forward to imagine how we can change our world for the better.

It’s hard to be hopeful this year, with war still raging, the climate crisis accelerating, and inequality rising. Closer to home, it’s particularly distressing to see the standards of care that the NHS can provide falling further and further below a humane and acceptable level. The government is proposing a limit on the rights of health workers to take industrial action, with the stated aim of ensuring a safe level of service. However, the erosion of safe staffing levels is one of the reasons health workers feel impelled to strike in the first place.

In general practice, we were busier over Christmas than we’ve ever been. The mishandling of public health messaging around streptococcus A infections and scarlet fever created a situation where parents who were perfectly capable of managing their children’s illnesses at home sought consultations and reassurance for viral sore throats. Alongside the very many toddlers with minor illnesses we saw a rise in patients seriously ill with flu, covid-19, and other respiratory infections. As a result of the strep A panic antibiotic stewardship was largely set aside, and a surge of prescribing led to predictable shortages, necessitating daily emails from our local pharmacies detailing the antibiotics left on their shelves so that we could tailor our prescribing to their stock.

At our practice, we seem to be past the peak. Demand has slackened a little, perhaps because some people believe again (as many did at the height of the pandemic) that the health service is overwhelmed and that their problems are trivial in comparison.

One of my jobs is to enthuse others and to convince my colleagues that, despite external events, we can still be the GPs we want to be and can give the care our patients need. We take turns to be duty doctor, so that the most stressful days are interspersed with other days where we see patients who’ve booked in advance. These are mostly people on our lists who we already know, coming either with new problems or to follow up ongoing conditions. I’m not sure that I’d be able to continue the job without this, although I know that some practices are so swamped with on-the-day demand that they can no longer run personal lists or build relationships over repeated consultations.

We have hope, in the shape of talented and committed new doctors in the practice and enthusiastic trainees. The year will turn, the viruses will retreat, and all governments eventually fall. For the sake of our patients, we just need to hang on in there and fight for the restoration of the NHS to what it once was—and what we know it can be again.