The Winds of Change

It is very hard not to be despondent about life in general practice these days. Readers of this column may at times dismiss my negative proclamations as the weary ranting of a burnt-out public servant and look for the next bright young thing with a spring in his or her step to inform everyone that all is well with the world of primary care. Sadly, the bright young things are not flocking into general practice, and fortunately (for me at least) I am yet to reach such depths of exhaustion to warrant the epithet of being burnt-out. However, as the 19^th century German philosopher and writer, Friedrich Nietzsche, wrote ‘if you gaze for long into an abyss, the abyss gazes also into you’.

To paraphrase the words of a former British Prime Minister, Harold Macmillan, the wind of change is blowing through primary care, and general practitioners are becoming increasingly fearful of the approaching storm. The latest squall blowing our way is the Government’s imposition of yet more contract reforms. These reforms, on top of all that has been brought about by a depressed economy and the on-going reform of the NHS in general by virtue of the ill-thought through Health and Social Care Act, may well become the final nail in the coffin for many practices.

The British Medical Association recently polled 8,000 GPs in England. The results do not make for comfortable reading. Accordingly to the poll, 13% of GPs (i.e. approximately 1 in 8) are planning to quit the NHS. Of these, some 63% are planning to bring forward their retirement and leave earlier than originally planned; many others are looking to move into different careers or seek work abroad. The reduced financial flow to general practices is also forcing many to consider making staff redundant; this in a business where spare capacity amongst the workforce is not to be found. The staff being laid off includes clinicians (i.e. salaried doctors and nursing staff). The survey also showed the true extent of GP morale across the country: 91% feel unable to manage the increasing workload, 97% believe general practice is becoming more stressful, 89% are less enthusiastic about a career in general practice and 87% said that they were less likely to encourage young doctors to become GPs.

The concerns are not just being expressed by dispirited GPs. The leading health lawyers, Hempsons, have predicted that general practices with less than 15,000 patients on their list will not survive the politically-induced changes. Whilst that may ultimately bring improvements in service provision for some areas, it is worrying to think that there are only two or three practices of that size throughout North Lincolnshire; the implications are immense, and will result in many amalgamations and practice closures.

If we think we have it bad in England, Welsh GPs believe that the entire system of general practice in Wales is at risk of collapsing. Conspiracy theorists would say that is what the Government is hoping for in England as well. I am beginning to subscribe to the same theory.

First published in the Scunthorpe Telegraph 27 March 2013

© Copyright Robert M Jaggs-Fowler 2013