General practitioners are victims too

Editor—Having just completed a series of eight meetings with some 500 general practitioners from around the country, I cannot believe the huge disparity between the espoused values of those who do not work as general practitioners and the near desperation of many who do.

Neuberger talks about patients not being consulted over the services offered.¹ No one ever consulted most general practitioners about the 1990 contract or primary care groups—these issues are decided at the highest levels. In the mid-1980s many of us could start reducing our list sizes and giving more time for consultations. Home visits were not a chore, and care could be more personal and continuing. I don’t care what the pundits say: the caring general practitioners who are still out there talk all the time about wanting to give more time to people and are frustrated at a professional level by their inability to offer the standard of care of which they know they are capable.

Most of what has occurred in my lifetime as a general practitioner has shown a complete lack of strategic coherence at the highest levels. The fact that we now apparently need 7000 doctors and 15 000 nurses serves only to underline this.

Part of the solution is to increase users’ feelings of control, but when people hear of spending sprees their first reaction is not to decrease their demand for services; however many bad doctors there might be, doctors in general are still fearsomely outnumbered by the great British public. People will vote with their feet, and that applies as much to doctors as it does to their patients; many doctors are just as confused by the changes as those they try to look after.

It is also oversimplistic to state that doctors know where to go when they are ill. Evidence from the Doctors Support Network shows that many (usually mentally ill) doctors are hopeless at knowing what to do when they are ill. They go to the same fallible specialists as their patients and end up, somewhat ironically, getting an abysmal service, excluded by the same old fashioned medical hierarchy and NHS structure that so damaged them in the first place. In truth, many general practitioners are as much victims as their patients are.