Having been an NHS GP for 16 years, nowadays two things go through my mind every day I am in my practice:
- How to take the line of least resistance to get to the end of the day;
- How do I continue to engineer my career to reduce my frontline GP work (having already succeeded in reducing it to half time over the last few years, while being able to pay the mortgage).
It has been said that GPs become GPs rather than specialists because of their independence of spirit. This tendency has become an increasing problem as we move further and further towards being micromanaged to the point of absurdity. The control freakery, lurking in the background for some years, has reached new heights with the new contract.
The tipping point for me has been intrusive interference in that central facet of general practice, which is the consultation. This is largely due to the QOF requirements. Still, the pragmatic GP tries to make it work, trusting the no doubt wholly admirable intentions of those who come up with the formulae for ‘good practise’. But making it work is often in the form of a ‘work around’ a system that is too complex and intrusive. Hands up those who have entered a systolic measured at 152 as 148 in the patient record, and then entered the code for the absurd ‘Mental Health Review’ while they are at it (it is unlikely anyone will actually check, isn't it?). Most of us just get on with it, because it pays the mortgage and we want to have a life rather than spend our lives at focus group meetings or conferences, or giving constant feedback to anybody who demands it.
Surely the time has come for us, the ‘ordinary GPs’ to demand a re-evaluation of the principles underlying the QOF, unless of course all the potential non-compliant doctors have already left the NHS? Is QOF likely to actually improve the quality of overall holistic care of patients, or just the quality of electronic coding to further its abilities as a management control tool, with annual incremental tightening of the screws?
Like most things in general practice one needs to try and get a feel for the potential benefits versus harms of the new contract. I don't see how the quality of the consultation is not being harmed by the present set up, but this is a lot more difficult to measure than checking for the right codes. In my view we need to find a way of trusting GPs with the freedom to do their job without constant interference, particularly if a robust system for individual revalidation is introduced. I won't mind if some computer nerd taps into my system as often as he wants and does all the interrogation he needs to do in order to test out the quality credentials of my work. Let these people do what they have to do, but please stop interfering with the area of my expertise.
I still have one foot in general practice, I am not sure that it will still be there in 10 years time. All I can say for now is thank goodness for the patients, and the observations and vitality of medical students and registrars who still have some room to think, and can see that there are always novel and alternative solutions to any problem. But I feel sorry for young GPs who will have no chance to work in an environment that allows for ‘discovery’, because everything is prescribed. For my generation of GPs I believe the zenith for general practice was reached when we were able to create novel solutions with fundholding and the out-of-hours revolution. It has now all gone sour.