The medical press paints a depressing picture of general practice. Apparently we GPs are a dying species, demoralised, burnt out, undervalued by the public and secondary care doctors alike.
It appears that the image of poor pay, ridiculously high demands from patients, and having to deal with constant trivia and mountains of paperwork is frightening medical students and young doctors away from general practice. Then there is the stress arising from the fear of ever increasing complaints and the pressures of revalidation and clinical governance.
How many doctors are made redundant or sacked?
Can all of this really be true? Is job satisfaction no longer there? Were things really so much better 10 or 20 years ago? And is it correct that most of us would not recommend medicine to our children?
I am one of the no longer silent minority of GPs who believe that things are not as bad everywhere as it may seem. Maybe it is because I am in a small practice in a rural area where demand is not so high. I have been here for 18 years, know the patients, and generally feel in control.
Life was much tougher when I started in 1984. Then I was singlehanded with poor premises, minimal staff, and little time off. There were no appointments and a huge visiting list. There was the constant stress of having 20 people waiting first thing every morning, some of whom had bizarre expectations. There was a measles epidemic my first winter. I did not get a holiday for nearly a year and even then locums were hard to find as most did not want to do a singlehanded stint.
Several times my wife and I seriously considered leaving but in those days there was a stigma associated with changing practices. There was a surplus of GPs and popular country partnerships could often attract up to 100 applications. There was no career structure and not much support from peers; it was “sink or swim.”
However, the challenge of changing the practice and reaping the rewards of developments and generally the support of patients kept us here and there was a gradual improvement. Social connections and better relations with other practices helped us to put roots down. General practice is much better for me now for many reasons.
I work in large, comfortable premises and have a part-time partner and a full team of staff. We have been in an out of hours co-op for six years, which has improved my family's quality of life beyond recognition without adversely affecting patients. Home visiting has dropped to about a tenth of what it used to be.
There is good communication with other practices through the out of hours co-op and local healthcare co-operative (LHCC). There have been opportunities to get involved in work outside the practice in GP education and LHCC activities. This raises awareness of the world of primary care and its standards and expectations. I now have a better grip on the clinical management of most conditions through the abundance of documents on clinical evidence and guidelines, which didn't even exist when I started. I have access to the local community hospital, which in the early days was denied. This helps to improve job satisfaction.
One thing that has not changed is that most of the patients are generally pleasant and understand their doctor's time constraints. It is impossible to say that general practice is not interesting or challenging with a vast array of problems to be tackled.
Revalidation does not really seem too onerous and could be a useful prompt to keeping up with ongoing educational and developmental needs. Clinical governance, although an ugly term with policing connotations, should really be a support structure locally to keep up quality standards.
Although we should be paid more in line with consultants, the new GP contract should provide a framework for bridging the career divide between primary and secondary care and so attract more young doctors. Opportunities to develop interests in intermediate care—for example, diabetes care and minor surgery—mean that young doctors should have no fear that they might lose skills upon entering general practice. Nurses can now do 25-30% of what GPs used to do and it is probable, given the right conditions, that GPs will be able to do a similar proportion of what consultants do.
Few other occupations come with the same job security. Many jobs seem just as, if not more, stressful than medicine. How many doctors are made redundant or sacked, have to change career completely, or go bankrupt?
Surely there must be other GPs out there who feel the same way as I do? Of course, many have genuine problems. If, for example, I had 100 heroin addicts on my list, it is likely that I would become demoralised and start looking for early retirement.
I think it is important to spread the message that it is still possible to be content and fulfilled in general practice. Otherwise the media's picture of doom and gloom will become a reality.