Think you can cope without us? Try it – and The five stages of grief for general practice

Readers might reflect on how a “valued profession” , all beginning their careers as altruists, can degenerate to this level of invective and negative thinking. Who is responsible Mr Hunt, and that do you have next for the profession? I have heard in the last week of doctors visiting Beachy Head – perhaps like lemmings we will all go there one day.

Dr Tony Copperfield rants in Pulse 22nd March : Think you can cope without us? Try it

Right, you complete and utter scumbags, I’ve had enough. When I say ‘scumbags’, I am, of course, referring to those who constantly mock the role of the GP in the NHS, either implicitly (for example, politicians forever redefining and micromanaging our job because they think what we’ve been doing all these years is worthless) or explicitly (media commentators and headline writers who are smugly certain that we’re pointless, overpaid slackers). And by ‘had enough’, I mean, exactly that. I’m really beyond the point of giving a toss whether that teetering edifice called family medicine, which we’ve valiantly propped up for so long, finally topples into oblivion.

Because, while letting general practice implode is deeply upsetting, like seeing your genetically encoded favourite football team go into administration (been there, done that), and might have significant personal ramifications, I’m truly beginning to think being prematurely retired/relocated/redeployed/unemployed would be worth it to give those bastard GP-bashers the NHS they deserve.

How long, do you suppose, before they’d be begging for forgiveness and for us GPs to return to the fray? I’d give them a few months, tops. And what fun we’d have, watching from the sidelines. Seeing risk-averse systems trying to cope with the uncertainty we shoulder every day. Seeing A&E swamped with trivia and inevitably missing the serious needles among the coughing, sniffling, whining haystacks. Watching pharmacists and nurses ‘manage’ chronic illness and scratch their heads whenever a punter wanders off-protocol. Seeing consultants deluged with unfiltered referrals and realising, too late, that what GPs are really, really good at is diagnosing and managing normality. And watching all of the above lead to overdiagnosis, over-referral and overtreatment, thereby driving a coach and horses through whatever NHS quantitative easing has been scribbled on the back of an envelope that particular week.

So go on. Get rid of us. Bring it on. Because those of you who doubt our value don’t have a frigging clue. Remember out-of-hours, and how well you thought you’d cope without us? Calculate the organisational, financial and reputational pain that caused you, multiply it a hundredfold and you’re not even close.

But what I’d enjoy most in a temporarily GP-free NHS is the expression on the face of one of the politicians/media pundits as they endure a totally unnecessary colonoscopy. That look will say, hang on, didn’t I have one of these last week? Who are these people behind the surgical masks, do they know my case, are they talking to the other six specialists involved, who’s co-ordinating this, has anything been omitted, what’s been duplicated, where does this end, who’s in charge, why do they talk to me like I’m a pathology rather than a person, what does ‘lesion’ mean anyway, who can I trust here and ow, that sodding hurts. In other words, an expression that asks, ‘Who cares?’

Who cares? I did. I cared so much I made a career out of it. But I’ll tell you what, I don’t care any more.

and previously on 10th March in Pulse Susie Bayley opines – The five stages of grief for general practice

I have been grieving.

It wasn’t expected, it took me by surprise. No one had died, I had had no terminal diagnosis, but the signs were there. I kept dwelling on the ‘good old days’, and the great time we had together. My mood was flat, sleep poor. I found myself staring at the empty wrapper (OK wrappers) of Green and Blacks chocolate.  Steadily the understanding hit, I, like many of us, are in a sort of mourning for the general practice of yesteryear.

According to the (slightly debatable) Kübler-Ross model there are 5 stages of grief: denial, anger, bargaining, depression, acceptance.

Stage one – denial.

I merrily continued denying the change to our profession, thinking I was OK and absorbing myself in work. I lost any form of lunch break and gobbled down a sandwich whilst working in front of the computer. I saw an increase in unfunded and unnecessary clerical work, and I did it. At the same time I saw the progressively pitiful practice finances.

But then something changed.

Stage two – anger.

Fortunately I had an excellent focus: a certain Jeremy Hunt. And when I got angry, I got really angry. I took to Twitter, using 140 characters to vent. My non-medic friends grew tired of my anti-JH, pro-NHS posts. I was quite generous with my anger though and shared it around a bit. Any silly DoH/NHS ‘personality’ and ridiculous policy was welcome to it. And frankly, I just needed to read the words ‘Care Quality Commission’ and I felt livid. If I’m totally honest, I don’t think I’m quite over this stage.

Stage three – bargaining

So stage three began, I bargained. How could I, and we, make things better? How could we salvage our profession. Social media galvanised us and new groups were born. We would work hard to come up with new ideas, and we would be spared. If I could work in a different way maybe I could prolong the life of primary care as I knew it.

Then, unsurprisingly, I became really low.

Stage four – depression

Most people who know me didn’t recognise the quiet, withdrawn being in front of them. The depression subdued me. And the cause was clear – a job that had been everything to me had changed unrecognisably. I no longer looked forward to work. I worried about patients and my own ability more than I had before. Every case could end in legal action or a report to the GMC. Every prescription could harm someone. I should have referred patient X, I shouldn’t have referred patient Y. I doubted every action.

Over the past few months, things have changed. Now my grief has ebbed, I’m back to being me again. I still miss the job that I had five years ago, and grieve for it, but my working life will go on.

I wish I could chat to Kübler-Ross though, I think their model is flawed. Stage five isn’t acceptance in this case, it’s determination. I refuse to accept this as an inevitability, instead I choose to fight for general practice.

Dr Susie Bayley is a GP in Derby and chair of GP Survival

LMCs need to get this message across: seeing your GP is no longer safe (Pulse Feb 23rd)

This entry was posted in A Personal View, Stories in the Media 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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