HILTON Adrian preferred

Adrian Hilton is a conservative academic, theologian and educationalist.

Right across the political spectrum, there is now broad acceptance that there’s a real and truly worrying recruitment and retention crisis in General Practice. Not only are experienced GPs retiring in droves; new medical graduates are avoiding that branch of the profession like a bout of Ebola. Surgeries are starting to close because of their inability to find replacements for retiring partners, with the inevitable knock-on for surrounding surgeries who have to adopt the dispossessed and abandoned patients.

It may be a tired old cliché, but this has all the makings of a perfect storm, or at least a medicative blizzard. It’s certainly not what the doctor ordered. As more and more GPs leave the service, it becomes increasingly unattractive to new recruits. And, since it takes several years to “make” a new GP, things need to change pretty damn quick. Time is of the essence: we’re dealing with people’s lives, so it would help enormously if politicians would get the solution right first time round.

Despite the looming General Election (and the political imperative on all sides to promise the electorate more for less), this is too important a problem for partisan sophistry or political spin. General Practice needs reform, and quick. And that demands an honest assessment of the complex issues and the abandonment of political posturing.

Let’s get the money thing out of the way first, shall we? GPs and their representatives have been complaining for years that General Practice is underfunded. Well, they would say that, wouldn’t they? What sector of the NHS would admit to being awash with cash? But perhaps, just this once, they’re right: the Department of Health has recently announced that they intend to channel a greater percentage of NHS funds into Primary Care. The aim would be, quite reasonably, to fund more staff to cope with the workload, and not just to fatten GPs’ wallets and subsidise their golf-club memberships.

But GP remuneration isn’t the real issue here: burnout is the problem. Even Jeremy Hunt acknowledges this as the cause of the current manpower crisis. And if the Secretary of State finds himself in agreement with GP representatives, then perhaps it’s time to sit up and smell the antiseptic. Jeremy’s solution (first name – I met him once; nice guy) to GP burnout (as promised at a recent meeting of the profession) is to do away with the traditional 10-minute consultation, allowing GPs more time to deal with the increasing complexity of patients’ medical conditions. A true politician to the end, he didn’t tell them about the other DoH initiative which permits this reform to be implemented: apparently the “NHS working day” is to be extended from 24 to 30 hours. Quantum physics is involved, I believe. Or at least the preternatural interruption of the earth’s axial rotation modelled on Joshua’s ‘long day’.

Jeremy’s well-intentioned solution is not remotely the quick-fix that this problem requires. Instead of just offering a prescription for a symptom, a good doctor (indeed, every doctor [with the possible exception of Harold Shipman]) would try to establish the actual cause of the illness before prescribing a potential cure. GP burnout is a product of two factors: 1) constantly-changing, top-down initiatives with bureaucratic targets; and 2) a veritable tsunami of patients clamouring for an appointment.

1) is easily remedied by the immediate cancellation of new hoops from the DoH and the withdrawal of a number of well-established ones. 2) is much harder to address, and might require a politically-unpalatable, eye-to-eye, straight-from-the-shoulder, up-front heart-to-heart.

On the run-up to May 2015, such plain-speaking might be a bit risky. Perhaps far too risky for Mr Crosby (surname – never met him, though I can attest he’s not a cuddly and warm sort of chap).

There are only so many seats on a bus. If the bus is over-crowded, the able-bodied would usually be expected to give up their seats to the elderly, pregnant or infirm. Most of us do it intuitively. Those who don’t can usually be embarrassed into doing so. Similarly, there are only so many GPs in England, and only so many hours in the day. I have a proposal. It’s a radical suggestion, I know, but at least it injects some honesty into the debate.

If I make an appointment with my GP, that’s one less slot available for everyone else. Likewise, if I can’t get an appointment with my GP, it’s because some poor suffering soul has already taken it (and I jolly well hope they’re sicker than me). But patients are consulting GPs nearly twice as often as they did only a decade ago. Is the nation really twice as sick as it used to be? Or is it that General Practice is a victim of its own warm-hearted success? You don’t have to be a genius to grasp that if we run a high-quality medical system that is completely free at the point of need, and then promise the customer an increasing range of services and improved access, more and more people will use it. What business could survive using this ever-expansive (and expensive) model?

Let’s have some honesty about capacity, shall we, Jeremy? Put the remuneration issue to one side, and let’s have a fair assessment of how many GP appointments can reasonably (and safely) be provided in a working day with the manpower we’ve actually currently got in the system. If demand exceeds supply (which it surely does) then we will have to ask some of the passengers on the NHS bus if they might be prepared to give up their seats to those who are more deserving. It’s a radical and potentially unpopular solution, I know. But at least it’s an honest one. You might have a better solution, so please share it. But it had better be sure-fire and fool-proof, because there’s only time for one shot at resolving this.

By the way, (for those who don’t know), BUPA offers a stress-free, capacious and highly agreeable alternative mode of transport, so who gives a damn about the passengers on the NHS bus?


33 comments for: Adrian Hilton: GP reform – please give up your seat to the elderly, pregnant or infirm

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