Declining.

I was going to post about the different conditions and symptoms I had seen over the course of a working week but then a tweet caught my eye and I felt I had to blog about it. The post in question was a thread questioning why there are dwindling numbers of GPs, so I read the comments….never read the comments.

After reading all of the replies I was left feeling somewhat bereft. Do the public really think me and my colleagues are lazy?  The answers seemed to be along the lines of ‘they just want the big money without doing the hard work’, or more interestingly ‘if they all worked full time we wouldn’t be in this mess’ and very worryingly blaming the problem on immigration.

GP numbers are falling and there are so many reasons for that. I work at least 30 hours across three days (75% FTE) as a salaried GP; some colleagues are doing 12 hour days week in week out. The work load is increasing as the years go by and this is unfortunately leading to a lot of GPs burning out. So no, the answer is not to make us all work four or five days a week as this in turn would just lead to more of us leaving the profession for good, or worse making us mentally or physically unwell and unable to work.

Many GPs nearing retirement age have opted to leave their partnerships earlier than they planned, this is again multi-factorial, and relating to pension changes and a dissatisfaction of the path the profession is taking. This will result in the loss of a huge amount of experience and knowledge in primary care over the coming years.

What else could be driving the numbers down? The job is hard, really hard. I am not moaning here, I am just stating the facts. I do enjoy it on the whole but it is relentless. More and more patients are seeking our help and support for both medical and social reasons. As GPs the buck stops with us and if no one else takes a patient on, for example if not enough capacity in community mental health services, then we as GPs have to take that on ourselves and ensure that patient is appropriately managed and kept safe.

When I applied for GP training in 2009, I was so excited. It was a hard speciality to get in to. York was always a very popular training scheme and I was worried I wouldn’t get a place. Recently the numbers applying to all GP training schemes have dropped and it has become difficult to fill all of the rotations. Some post foundation year’s doctors are heading abroad, having years out or trying out non-training jobs with more flexibility.

We need more GPs. We need them now.

We are using allied health professionals where we can, these include: advanced nurse practitioners (ANPs) who are trained to do the majority of ‘standard’ GP work and urgent care practitioners (UCPs) who are generally paramedics that have opted to do urgent care work in the community sector. We also employ clinical pharmacists along with a whole team of ‘prescription admin’ to help deal with the vast number of repeat prescriptions and drug queries that we receive on a daily basis. We have MSK (musculoskeletal) clinicians that can take the load off seeing new onset joint or muscle problems. Nurses can train to be prescribers or take other courses to allow them to do minor illness or run diabetes clinics for example. We have to diversify if we want to continue to offer the support and care needed to this growing population.

So, as more traditional GP work is being passed to other professionals, GPs are increasingly only seeing the more complex patients. I tend to see a lot of elderly with multiple conditions, patients with varying mental health conditions and a lot of women’s health in my routine surgeries. When doing urgent care I see the less straight forward patients along with the young babies who might need a more detailed examination.

So if you are a medical student, foundation year doctor or a clinician in another speciality looking to change careers I am going to give you my reasons why you should consider general practice:

  1. Variety. You never know what signs and symptoms you will see over a day. Each session you work something will surprise you.
  2. Time. The opportunity to get to know a patient over weeks, months or years. Follow up and continuity of care is important, it is more challenging now but is still possible where necessary. It is so useful to know how that patient fits in to the community, who they are related to etc.
  3. Flexibility. You can choose to teach, train GPs, work for the CCG (Clinical Commissioning Group, they are responsible for planning and commissioning local health care) or even specialise in a specific area as a GPwSI (GP with a special interest). There are so many opportunities when you look for them. You can choose to be salaried, locum or be a partner in the business. The ‘portfolio GP’ is on the rise this is a GP doing a mixture of roles across the week.
  4. Friends. Some people assume they won’t enjoy general practice as they think it might be isolating sitting in the same room all day. I find it offers the complete opposite. I have built some great professional and personal relationships with receptionists, nurses and doctors alike over the past 4 four years at my current practice.
  5. Team. Following on from making friends, I do firmly believe that when we work as a team both the clinicians and the patients benefit. This is team working within the practice and also with our hospital and community colleagues. My practice had a few teams complete the Yorkshire marathon team relay last year and it was the most fun. I got to know team members I had never met before. I definitely recommend!
  6. Tea and biscuits. Always a plentiful supply.

I do love general practice but I find it hugely challenging and I think it will only get harder but that can be said for all medical specialities. Before you think us GPs are being lazy or work shy, consider what the job is actually like, and remember as a profession we are trying to do right by you all day in, day out. If there’s something your practice isn’t doing well feed it back to them in a constructive way or if they are doing well we always appreciate a thank you, in fact it makes my week when I get a little message or card of appreciation!

3 thoughts on “Declining.

  1. Emma B says:

    Couldn’t agree more Abbie! General Practice is a wonderful, demanding and vocational career choice. As we work through some very challenging austerity times with health service transformation being pushed forward due to necessity, the pressure on primary care to maintain the current service offer is unprecedented!

    Ultimately, we are moving towards a GP being a “consultant” as they co-ordinate care via the skill-rich team, as they have a uniquely valuable set of skills (gained over 5yrs medical school, 4-10yrs postgraduate training) to manage holistic care.

    Like

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