Shocking: A brutal system designed to fail – both doctor and patient

At a mentoring meeting in Wales, junior doctors described their overall experience to mentors. We mentors were shocked to hear about a brutal system designed to fail – both doctor and patient. The trainees feel unloved, uncherished and like they are on a conveyor belt delivering items of service. They feel worse off in a 40 hour week than we did 40 years ago on a 90 hour one. There is no “team” in many hospital posts, and support and advice from disengaged seniors is very limited. Continuity of care, whereby a hospital junior could follow a patient through their stay has been abandoned. In General Practice trainees described lack of real “hot review”, whereby they can have access to advice and support immediately after seeing a patient, has been neglected simply because the training practice partners are working so fast.

The RCGP recognises the stress that it’s members, both juniors and locums and seniors are under, and has a mentoring service in development. Unfortunately the word “mentor” seems to have put people off. Certainly attendance at a meeting called to explain the proposed service was poor. We discussed alternative terms and “listening guide” seemed an alternative.

In this “management led” service, which pays lip service to being “patient led”, some of the fundamentals have been lost. Full time for GPs is becoming to mean working 3.5 days a week, and the partners who work 9 sessions, and stay sane, are becoming rare. Patients and their families are not ill on 3.5 days a week, so continuity is lost in GP as well as hospitals. The RCGP first five imitative (Mentoring, Networking, Connecting with the College, Revalidation and CPD support) is worthy but failing. Mentoring has become confused with clinical supervision in the minds of the trainees. If it is  as part of the deanery establishment it will fail.

The GP is defined no longer in the terms of the founders of the college. Then it was “continuing personal and confidential care to patients and their families, looking at making a diagnosis in physical, psychological, and social terms. It included health education and prevention services, including sharing ante-natal care of pregnant women when the groundwork for a long term relationship was established.

When I was near retirement a patient came in with her 16 year old daughter. We dealt with her problem, and as she got up to leave she said, “you may not remember doctor, but my daughter is the last patient you delivered”. She thanked me and left. To my shame I had not remembered she was my last – but what was important was that the patient had.

When I was a junior doctor we had a “mess”. Nobody else came in the mess except the kitchen staff. Consultants had their own dining room. We could let our hair down, indulge in non PC jokes, and laugh inappropriately at death itself. This was therapeutic and we felt cherished by an establishment that made it clear we had value. The approach methodology of Mr Hunt in imposing the junior contract, when they already feel disengaged and unsupported is yet another nail in the coffin of a profession bruised and brutalised.

The problems are endemic, and will take time and leadership to resolve. In Balint terms, we have not started, and indeed are going backwards. Mentoring takes time: speed mentoring is an oxymoron. In Wales at least, the new contract is not being imposed. Will this be enough to reverse the recruitment problems?  I doubt it.. Balint groups could be a more effective, and a cheaper way of getting mentoring accepted than any other… Doubtless “rationing” will ensure this does not happen. I left feeling things could only get worse.

What type of leadership is needed now to save the health services?

GP trainee map reveals stark north-south recruitment divide

GPs on the press/media rack. The Balint approach.



This entry was posted in A Personal View, Rationing on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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