Bob Bury

GPs must work harder – really, says who?

I’ve been quietly seething all day about an article of incomparable daftness that I read in The Times yesterday, and as it involved the NHS, it was up against some pretty stiff competition. Mind you, I deliberately avoid The Mail on health grounds (my own), so it’s quite possible that I’ve missed some even more inane commentary, although frankly I doubt it.

The article was entitled ‘GPs must work harder – it’s an emergency’, and it was written, or perhaps spewed out would be more appropriate, by Alice Thomson (follow this link, but it’s behind the paywall).

She was, of course, talking about the current problem in A&E, the genesis of which is clearly multifactorial, but which she feels is due entirely to the fact that GPs aren’t working hard enough. It’s difficult to know where to start in refuting her arguments, but I’ll pick just three of her points, and you can decide whether or not they constitute the most egregious pile of codswallop you’ve heard in some time.

Firstly, she tells us that her brother-in-law’s father was a GP 20 or more years ago and ‘his wife used to answer the phone at 3am and he would slip out to visit the ill’. Apparently, being a GP was not a job to him, it was a vocation…and you can probably fill the rest in yourself. So Alice believes that if GPs went back to being available 24 hours a day, and assuming that their liberated, right-on wives  (people probably not unlike herself) thought it was any part of their job to act as unpaid receptionists and health advisers 24/7 as well as bringing up children and holding down a day job, our A&E departments wouldn’t still be awash with the feckless worried well?

I don’t think so dear (excuse the condescension, but this has been festering all day. She will no doubt have me down as a typical arrogant doctor anyway, and I wouldn’t want to disappoint her).

She might also like to bear in mind that the same dependency culture that leads people to go to A&E with chewing gum stuck in their hair or because their child has nits (two examples given by Ms Thomson herself) is also resulting in overflowing GP waiting rooms – they don’t all go to A&E. That’s one of the reasons that the workload of today’s GPs is way above anything experienced by her brother-in-law’s father (but not the only one, see below).

She then goes on to make another, related point. This time it’s the old chestnut about the average GP ‘only’ being in face-to-face confrontation with patients for 22.5 hours a week. That figure is quoted so often, it must have come from somewhere. It may even be true, although I dare say that many GPs would question its application to their own working week. But if it is true, so what? Does she really believe that personal consultations are all that GPs have to do? That’s a rhetorical question, and it would seem the answer is ‘yes’, so let me put her right.

Today’s GPs not only have a mountain of government-manufactured paperwork to complete and hoops to jump through, they also have to read, digest and act upon the results of all the pathology tests, x-rays and scans requested on their patients. Even 20 years ago, the volume of this type of work would have been much less, and what there was was much less complex: not only were there fewer patients, but the range of tests now available to GPs is much greater – many of them hadn’t even been invented in Alice’s brother-in-law’s father’s day (I can’t keep typing that – let’s just call him ‘DF’ for Dr Finlay).

What’s more, many of the conditions now routinely managed entirely by GPs would simply have been referred to the hospital at the outset. Then of course there are the referral letters for those patients who do still need specialist opinions, and the resulting clinic letters to read and act upon, not to mention the work involved in running their practices, many of which are medium-sized businesses with dozens of employees.

And before I leave this particular non-issue, I wonder how many hours MPs spend in face-to-face consultation with the constituents they serve? And how many hours do lawyers spend sitting down with their clients? It wouldn’t do Ms Thomson any harm to spend a few days shadowing a GP before she treats us to any more of her uninformed opinions.

And finally, the crowning glory of this steaming heap of ordure. After speaking in such glowing terms about the selfless devotion of DF, she tells us that vets still provide that sort of service, giving as her example a recent episode when she fell from her horse. She tells us that she bravely just ‘took a few paracetamol and strapped myself up’.

On the other hand, when the vet arrived, he immediately summoned an osteopath (presumably for the horse) – ‘I could only look on enviously’, she whines. Yes, Alice – and your point is? If she’s telling us that her bruises merited the services of an osteopath, then she was at perfect liberty to consult one, and pay the fee. And if she’s saying that everyone should be free to demand that particular service on the NHS every time they fall off something, then, as a solution to the current resourcing issues we face in the NHS, it leaves something to be desired. I suspect she’s simply venting her general dissatisfaction with doctors by including this totally irrelevant anecdote, making herself look ridiculous in the process.

And she can’t finish without coming back to the selfless and inexhaustible DF by trotting out  that rather tired accusation that ‘in 2004 GPs negotiated a deal allowing them to  ditch evening and weekend work while at the same time receiving a 45% pay increase’. Now, since research is apparently a foreign concept to Ms Thomson, let me help her out here by pointing her in the right direction. Fortunately, I don’t have to enlighten her myself, because the history of the out-of-hours debacle, engineered by New Labour, has been elegantly set out by Eric Rose, a GP who was actively involved in the reform of the GP OOH service, here.

I’ve no doubt there are some GPs who are not pulling their weight, just as there are some MPs, plumbers, journalists and hospital doctors who could do better, but to blame them, as a group, for the chaos in our A&E departments is just plain lazy. It’s difficult enough trying to cope with a government intent on dismantling the NHS and selling it off to the highest bidder, without the additional burden of such ill-informed media comment.

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4 Responses to “GPs must work harder – really, says who?”

  1. Bob Bury says:

    Have since discovered that Alice Thomson is married to Edward Heathcoat-Amory a columnist for the Daily Mail (and the nephew of the Conservative MP David Heathcoat-Amory).

    Wow! Just imagine the free-ranging, erudite and evidence-based conversations they must enjoy over the breakfast table.

  2. Dr. JAM says:

    Have been curiously following the movement of events over the past 3-4 years. It has come to such a state that I would greatly appreciate a looking glass into the future to see how things will be 5 years from now. How much longer will GP’s take all the s**t being thrown at them in addition to working like a d*g? Probably the fitting reply to this would be that GP’s leave the NHS contractual farce en masse and go back to being private providers. This alone will restore some sanity in the craziness going on. But will GP’s ever unite to do this? I know not–but better realise sooner or later that this is the only viable option to retain dignity and independence as well as longevity!

  3. rob m says:

    great article – I would love to see it in the times. It seems that things are only set to get worse, with increasing pressures on GPs and a sustained anti-GP assault by the press

  4. Jok says:

    Does nobody get it?
    They are privatising the NHS

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