It was the best job in the world – for me 1979-2012 – but now there are not enough of us to cover the country. So what has happened to General Practice to make it so stressful and unrewarding? Why is it that a survey conducted on 500 GPs and published by ITV headlined (Ros Osborne 9th March 2015) : The Welsh GPs who plan to quit and work abroad because of “excessive pressure”.
In 1966 there was a new contract which encouraged partnerships and new premises development. Between 1966 and 1998 General Practice was in it’s heyday, constantly improving, computerising and developing training, and in one year (around 1986) almost every medical student in Cardiff University (it seemed) applied for a GP training post. Then in 1998 the first performance indicators (PIs) were introduced (smears and vaccinations) followed by a ramping up of PIs to end up in the Quality and Outcomes Framework (QOF) in 2004. GPs were surprised (BBC News 30th Jan 2007) to be allowed to escape from the 24 hour contract and their Out of Hours commitment (OOH), in return for Health Prevention and Promotion, and Screening for Chronic Diseases and then managing those chronic diseases CDM). The room for choice and movement within the job became less, as the intensity of the days became greater. GPs moved from doing very long but less intense working weeks, to shorter but much more intense days. There were more opportunities for women, who naturally were attracted by the ability to avoid antisocial shifts, and medical schools realised that women performed better at A levels than men, so 80% of medical undergraduates became women. Recent trends to ask GPs to man evening and weekend surgeries in England, have not been matched as strongly in Wales, as more of the population is unemployed or retired, and there is less demand for these clinics. Despite this, Wales and Scotland do not attract enough doctors, particularly in the rural areas. Scotland has always trained an excess, and Wales too few, but even the excess has not helped Scotland. There is a world market in Doctors…. (It’s the competition silly. Just as the Health service is a “market” for services, the world is for doctors. More and more doctors considering emigration, and a snowball effect is possible). People are living longer, and their symptoms are complex. The 5-10 minute consultation paradigm is not long enough for elderly people, often slow to express themselves, undress and dress, and gain “informed consent”. Interview and consultation “rape”, (John Heron) whereby speed is the vital factor is now commonplace. The result could be more and more demand for private GP and Consultant appointments, especially in cities, and a two tier service.
In Canada there is an inducement to work in rural areas, and special training to be a complete independent practitioner in out of the way places. Grants are given preferentially to those in these locations, and even the political posts are preferential to those in rural locations.
Doctors have told ITV News 9th March that they plan on quitting Wales and moving abroad to because of stress and high workloads. An exclusive survey of over 500 GPs by ITV Wales in conjunction with the Royal College of GPs found doctors facing excessive pressures, lack confidence in the future and wouldn’t pick a career in general practice if they had their time again.
The RCGP Wales chairman, Paul Myres sent the members this e-mail:
“A survey of over 500 GPs conducted by RCGP Wales and ITV Wales has found that doctors are facing excessive pressures, lack confidence in the future and wouldn’t pick a career in general practice if they had their time again. N Wales LMC Chair and RCGP Wales Chair Paul Myres were interviewed on ITV Wales for Monday night, which can be viewed here.
Scotland is facing a GP recruitment “crisis”, with almost a fifth of practices reporting a vacancy, the British Medical Association has claimed.
Its Scottish GP committee found that 17% of 463 practices surveyed had at least one vacancy for a GP.
The organisation warned that the situation would affect patient care.
But the Scottish government said Scotland has more GPs per head of population than England.
It said difficulties in recruiting GPs was “not an issue unique to Scotland”.
And it said its investment in primary care had seen the number of GPs increase by 6.9%.
In its report, the BMA said that three-quarters of the practices it had surveyed said that they were unable to secure locum cover on at least one day over a one-month period while some practices reported being unable to secure cover for 15 days or more.
The organisation, which represents doctors and medical students, warned that the situation threatened patient care and called on the Scottish government to work with it to improve the recruitment and retention of staff.
Its survey was released in advance of the annual conference of Scottish local medical committees in Glasgow.
Dr Andrew Buist, deputy chair of the Scottish GP committee, said the findings supported anecdotal evidence from GPs.
He said: “Scotland is facing a GP recruitment crisis which is being further exacerbated by difficulties in securing locum cover.
“An ever-increasing workload, combined with falling resources, has led to a reduction in the number of doctors choosing to train as GPs while senior GPs are choosing to retire early or work abroad for a better work-life balance.
“This will inevitably affect the care we can provide to our patients. A high vacancy rate translates into a decline in the number of available appointments – reducing access to general practice at a time when we are trying to treat more people in their communities.
“The findings from our survey also illustrate the need for urgent action to ensure that we are able to recruit and retain GPs now.”
A Scottish government spokesman said it “continues to support, build upon and sustain Scottish general practice”.
He added: “We’re working with health boards and the medical profession to develop short-term recruitment initiatives as we look to develop more attractive medical career pathways. The BMA is a key partner in this work.
“The Scottish government has invested £50m in primary care and community premises across Scotland this year. This is additional to the £250m investment in community-based health facilities through the Hub programme.
“In addition, our primary care development fund will ensure our GPs and primary care professionals can help our health service evolve to meet the changing needs of the people of Scotland.”
Elderly care standards ‘not met’, SCOTLAND