Today I’ve been working as a sessional GP in a village practice near Cambridge, seeing the usual mixture of common colds, hot children, lumps needing urgent referral, heart attacks, depression, and the worried well. Around me, in leafy Cambridgeshire, GPs are worrying about the recruitment crisis in primary care, with as many as 40% of GPs due to retire in the next five years.
A 48 hour strike
Junior doctors are going back to work after a 48 hour strike over the imposition of their new contract. Administrators are trying to fill rota gaps without spending any money, and patients are trying to negotiate the complex bureaucratic barriers we’ve put in their paths to try to limit demand in the NHS.
On the wall next to my desk is a crib sheet about safeguarding vulnerable adults, reminding me to remain vigilant as patients pass through my care. It contains some definitions:
“Professional abuse is the misuse of power and the abuse of trust by professionals, the failure of professionals to act on suspected abuse/crimes, poor care practice or neglect in services.”
“Institutional abuse is the collective failure of an organisation to provide an appropriate and professional service to vulnerable people.”
“Neglect is behaviour that results in a vulnerable adult’s basic needs not being met.”
Reading the crib sheet, I realise that the vulnerable adults around me are my colleagues. I see general practice principals and assistants at their wits’ end, with unsustainable increases in workload and expectation. I talk daily with junior doctors who have punishing rotas, poor teaching, and training programmes that fling them around the country and separate them from their families. Just as vulnerable women come to be locked into abusive marriages through love and duty and a lack of practical alternatives, so doctors become trapped by their sense of guilt and responsibility, diligence, and mortgages.
Many of us foresaw that the Health and Social Care Act would wreck the NHS, that the abolition of primary care trusts by the former health secretary, Andrew Lansley, was like knocking down a load bearing wall to improve the view. Piecemeal privatisation of the NHS would bring it to its knees. And I see this happening with a sense of grim foreboding. The NHS exists only if we will it to do so; the government has lost that will. The rhetoric is fine, but the neglectful behaviour is clear, and now the bruises are showing.
Misuse of power
Jeremy Hunt, the government, and the Department of Health have misused their power and abused the trust of the medical profession. They are guilty of poor care practice and neglect of services. They have failed to create an organisation that provides an appropriate and professional environment in which to work. The result is that the basic needs of the vulnerable workforce are not being met.
Junior doctors have no recourse but to strike, dependent as they are on their training programmes and references. GPs can vote with their feet, and increasingly they are doing so.
Corporate failure has been identified in many areas of life in Britain. It’s time we spoke truth to power and called the government and the Department of Health to account for the abuse of its vulnerable workforce.