Looking into the tea-leaves

Anyone who has opened a box of Twinings tea will be familiar with the quotations on the inside lid. One is from George Gissing (a 19^th century English novelist), who is reputed to have said 'The mere chink of cups and saucers tunes the mind to happy repose'. It is in the spirit of trying to induce even a mild state of euphoria that I am now drinking a large cup of Breakfast Tea whilst writing this article. However, the conversion is proving to be a challenge, and I will explain why.

My medical career began in 1980, when I entered a London medical school with tremendous enthusiasm and the single focus of qualifying and practising medicine. Even then, I knew I wanted to be a GP, despite various professors trying to sway me in other directions. I was one of the lucky ones, having previously gained a place in one of the country's top grammar schools, and then, with the aid of a decent student grant, topped up by a small scholarship award. I was, as the saying goes, upwardly mobile.

    After several years of working a long and arduous passage through a variety of junior hospital jobs (120 hour weeks were the norm), I landed in North Lincolnshire and had the great fortune of being offered a medical partnership. For the major part of the past twenty-one years I have tried to offer a decent quality of service to my patients; many of whom, by virtue of living within a small community, I would now call friends. The long working days and pressured demands have been compensated for by the firm belief that I have been helping others in need and putting something back into society.

    Now, in 2011, the present NHS reforms have overturned my enthusiasm and ideology. Whilst it is true to say that I still enjoy the individual patient-doctor relationships of everyday general practice, the pathway the NHS is now being forced down makes me increasingly look for alternative ways of spending the next decade of my working life. Such a statement comes as a surprise to many who have known me for a long time. However, the truth is, I (and many others on a national basis) fear for the future of general practice in particular and for the future of the NHS in general. Along with a large proportion of my GP colleagues, I can see through the political rhetoric of 'giving GPs the power to run the NHS'. Whilst it is true that we are to be given the responsibility of keeping within restricted budgets (not a bad thing when dealing with tax-payers' money), the exhortations of the Secretary of State for Health that the reforms are going to 'free up GPs to spend more time with patients', 'empower clinicians to make the decisions', 'liberate the NHS', and that 'the majority of doctors support the reforms' are, many of us believe, far from the reality.

    It is true that there are a few doctors who are enthusiastic about the changes. There are slightly more who are pragmatically getting on and trying to make something decent out of the reforms. However, the majority of GPs are disquieted and fearful; certain that the changes will see greater privatisation of NHS services and hospitals, a loss of experienced managers, greater demands on GPs' time in respect to running the service rather than treating patients, increasing pressures to achieve unreachable targets, insufficient money to provide a decent service, closure of some hospitals and surgeries, and ultimately a dismantling of primary care as we know it. Of course, GPs will get the blame when it all goes wrong (nothing new there), whilst those presently in Government, who should carry the responsibility for the wholesale destruction of our national health service, will have moved on to pastures new. In the meantime, it is you, the patients, who will suffer.

If you think I write as a burnt-out fifty-year old GP who can no longer stand the pace, you are quite wrong. However, I am angry, demoralised, and reflectively surprised that I should find myself seriously considering a career change after years of enthusiasm for life in medical practice. I strongly believe that the nation needs to wake up to what is happening before it is too late. Don't swallow the political rhetoric without reading the label; there are some serious side-effects to these present reforms, and many of them are yet to become apparent. Use your wits and start asking questions of your MPs and doctors. Seek out the truth and then decide whether you personally wish to influence the changes before it is too late.

There, I have said my piece. As I drain my cup, I am mindful that Noel Coward once asked 'Wouldn't it be dreadful to live in a country where they didn't drink tea?' I quite agree, although I find myself wishing I hadn't used a tea-bag; a few tea-leaves may have helped decipher the future. As it is, looking at the bottom of my cup, there is nothing there. Then again, perhaps that is also the future of the NHS as we know it...

First published by in the Scunthorpe Telegraph, Friday 1^st April 2011