I’M JUST A GP .
This is a piece of therapeutic writing and god knows as GPs in the NHS we all need a bit of therapy now and then . There will be no ” visions ” , ” journeys ” , ” taking this forwards ” or other such mind numbing phrases that irritate all of us and make us play bingo at presentations and meetings .Try it if you’re bored at the latest announcement on ” how to reconfigure and save the NHS ” count how many times you hear those phrases and the first one to 69 or whichever else number you choose wins. Brightens up the meeting no end .
The real reason for this is two fold , no origami pun intended .
The first is personal , I’m approximately 25 years in to my career in medicine and general practice and at a bit of a cross roads so it is working out to me what is really important for the next however many years I do this , lucky as I was to come in to this profession with a pretty pure motive ,patients .
And secondly because I love general practice and I want to protect it , not enshrine it, not embalm it, not stop evolution but do exactly the opposite by stopping those people who believe that the sub specialisation of every branch of this job I do is the only way forward , to be frank that’s testicles .
At this point let me apologise to anyone who is reading this for my English skills , grade c 16+ English , for the record that wouldn’t even get you to medical school these days but that’s a whole other discussion .
I am extremely privileged , I do a job I fundamentally love, in an area of the country that is stunning , I have patients who are fantastic, vibrant, interesting and have become my friends ( rural GPs still have this ) . I work in a partnership that has been going as a single business for 120 years, all my partners past and present are excellent , caring ,compassionate ,competent doctors who have worked as a team , we include as partners nurse practitioner and practice manager .My kids go to local non fee paying schools and have grown up in idyllic circumstances and all this from a working/middle class comprehensive boy who was told to look at polytechnics as I may not be able to do medicine ( should have mentioned bloody minded Yorkshireman )
So with all that why the hell am I writing this ,and that as they say , is the point .
The other day there was a bit of a eureka moment , don’t worry you can remove the picture of me in the bath from your head because I was watching athletics .
GENERAL PRACTICE IS THE DECATHLON .
The crown of all events, the multi skilled, multi talented , balanced individuals who know their own areas of strengths and weakness. They practice harder on those areas they struggle with , they look externally for help and coaching from experts in the areas they need to, but the focus is always the same . To achieve your personal best in every area ,to try and achieve the best possible overall score ie patient care . I know the heptathlon is performed by women in modern athletics but this isn’t about gender , a GP is a GP .
‘m feeling quite gladiatorial writing this but must tone it down as I am sat on a balcony in Greece and much as the olive wreath is near to hand the Spartacus look went years ago !
And the decathlon analogy moves on in to all areas and is one of the main reasons I am questioning what I do next .
Let me allude . GP is one career that gives you great autonomy, opportunity to just do things , not faff , not put it through a committee, just do it and you take the consequences . I love that , I don’t always get it right , I hope I have got better at listening and reflecting as I get older but what a great mover for change. The problem is the powers that be have started to try and stop that . One question you should always ask is when someone says you can’t do something just say ” or what ? ” . The replies are often very enlightening. Rebellious streak in me always gets the better and if you are acting in the patients best interest as an independent practitioner then it is not your right, IT IS your duty. I have lost count where the micro managing numpties have stated, it has to be on this form , written this way , to this person , with these details, on a Friday am between 8 and 8:30 if your names Brian and etc etc etc .
I am a decathlete, I will do my best in my events , advise me, but you do not do my event and if you are not helping me then please go away .
And the encroachment of secondary care modus operandi in to primary care is stifling and I believe harming overall patient care . Just for devilment here the next time your local acute trust looks at a significant event if you write and complain ,specifically ask them to look at the area of psychological damage to the patient . “well they didn’t have full blown cancer so the delay in the CT scan result caused no harm”. tell that to the quivering wreck in front of you who has planned their funeral, sold the silver and is all but dead and buried in their head. And that is one of the fundamental differences , we understand that , in general practice we care about those things, we try and empathise and understand .
I am a decathlete, I will do my best in my events , advise me, but you do not do my event and if you are not helping me then please go away .
Recently we have been informed re incontinence assessments that they must go to the appropriate team . Let me explain when you finally get round to broaching the subject with said patients/relatives. You want to strike while the iron is hot and need some help now, its not medically urgent so you can’t justify an urgent referral but if you wait for the six week routine one then the patients think, why did I bother I should have just put up with it . Well we used to use common sense, someone within the team would have a brief chat , give some interim pads/advice and await formal assessment . Well apparently that’s not allowable as they may not give exactly the same advice as the inco team , as my kids would say ” no shit Sherlock ” . The whole point is they aren’t the inco team but they are there and available .We are giving as the military say 80% ie 80% of something is better than a 100% of nowt .
I am a decathlete, I will do my best in my events , advise me, but you do not do my event and if you are not helping me then please go away .
And all these people are well meaning , pleasant and believe they have their place in the system but if you listen to the patients most of them are happy with generalism . The encroachment of work from secondary care is beginning to make our jobs untenable and if we stick with the decathlon analogy I am being asked to take extra events on , do the events I do twice with less training time , less coaches , less rest and all the time being told its good for the overall score , well do you know what , its NOT !
For the first time recently in this job I have properly started saying NO and that is soul destroying for me , but it has to be ,as I firmly believe as a profession if we don’t then the patients will suffer and as individuals we will crumple .We cannot provide safely more and more for less and less .So the message from me to the profession would be ” DEFINE YOUR CORE “
I can hear all the politicians going ” that old chestnut, next ” but bear with me
If every practice defined their core contract work and then wrote to their NHS England coordinator with it laid out and stated that outside of that any other work would incur a fee or would be returned then it would set some things in motion . It would establish a contract dispute, in my county possibly 70 of them , can you imagine the chaos, disastrous in some ways but i see no other way of effectively negotiating with them because they are being pressured so highly from above . And hopefully out of that chaos comes some common sense where we are allowed to get back to doing what we do so well .
I am a decathlete, I will do my best in my events , advise me, but you do not do my event and if you are not helping me then please go away .
Should be our mantra for everything we do , contracts, community care , coal face consultations , negotiations , federations , lmc , ccg etc
So on a personal front I will fight with every last breath to protect my patients care from those who are trying to dismantle and fragment a system that has evolved in to I believe the best family medicine in the world . As a system we need to say “NO”, loud and clear , for those elders leaving the job I don’t blame you .But please help, offer counsel and for those just entering who want to be salaried, non principal , welcome .How can we help you stay ? and did you know how wonderful this job once was, and if we stick two fingers up hard enough will be again .
To those between the two like me ,look after yourselves on the 12-14 hour daily grind, your families and friends are your saviours, exercise when you can , shout, get angry , that’s fine because it is bloody frustrating at the moment but maintain the purity , if you can , of the patient focus and the slightly rebellious streak that gives us hope .
And remember in all our dealings today whether community , secondary care, ccg, cqc, external agencies, NHSE ,capita, etcetcetc then ask of them do they pass the decathlete test , if not then …….
I am a decathlete, I will do my best in my events , advise me, but , you do not do my event and if you are not helping me then please go away .
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