Perhaps, if we work less hard

I agree with Heath, but the reality of being a general practitioner (GP) can quickly erode noble sentiments.¹ In my 20 years as a full time GP I very much wanted to work by the tenets in this article. But being a full time GP with an average list is hard, hard work. It is not just easy to get it wrong: getting it wrong, very wrong, is part of the process.

The work rate of most GPs is damaging to both patients and doctors. That work rate or “busyness” is often used as an excuse for “getting it wrong.” However, it is that work rate which makes GPs so economical. To complete that argument, GPs are efficient and cheap because they half do things. Usually we get away with it and we will use our “luck” to rationalise our failures. But that is changing, and in my latter years I saw standards rising and GPs trying much harder to do a better job. The current system is not designed to deliver that service. Add in the internet and rising patient expectations, and the current system will probably fail.

Yes we can do more in practice, yes we can keep people out of hospital, yes we can really be that holistic ideal—but only with lots more time per patient. That of course means much smaller lists, lots more doctors, and in time perhaps less pay. At the moment it pays doctors to work too hard. That incentive may need to be removed.