WINNER OF THE KIERAN SWEENEY PRIZE 2016*
I have always found denial an excellent strategy. For years I had listened with scepticism to reports of a crisis in UK general practice. In my surgery things were ticking over reasonably well. Then in May 2015 I had a bit of a crisis of my own. In transition to a new partnership structure I faced a few months of relentless on-call. I noticed myself become less caring towards my patients, less diagnostically curious, and less assiduous with my clinical records. My partners confronted the issue in a supportive way, the staffing issues resolved, and I regained my equilibrium, and with it a keener sense that all is far from well in UK primary care.
Doran et al’s paper in the BJGP gives a sobering account of why so many GPs are getting the hell out of practice, citing impossible workloads, degradation of the doctor–patient relationship, and negative media portrayals.1 These troubles are the cause and the effect of a recruitment crisis. A friend is a rural GP. With one partner down and a second due to retire, he simply cannot recruit. A dynamic training practice is on the brink of closure. In his patch, only three out of 15 GP training posts are filled. Now that is a crisis.
Our quandary has elicited a valiant response from the RCGP and research is underway to anatomise the nature of GPs’ occupational stress. Initiatives are aimed at emphasising the good bits, supporting ailing GPs, and campaigning for better funding. But might there be things so fundamentally wrong with general medical care that no amount of good money or good will can fix it? And in the face of such anomalies, is now a time for some fresh thinking?
This essay seeks inspiration from a system that works blisteringly well. …