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WH Smith (the son of WH Smith and son) became a successful conservative politician. In passing, Wikipedia informs us that WH Smith's commercial success began with the start of mass railway travel in the 1840s, and that the stations were packed with people waiting for trains. So, WH Smith (the father) set up railway shops to sell them things to read. I note that Paddington station still has a WH Smith and son but, from memory, now also sports at least 10 outlets for buying food and drink, so that passengers can graze while they are waiting for trains. And we wonder why we have a growing problem with obesity. Just an observation. Back to WH Smith (son). His appointment as First Lord of the Admiralty was mercilessly parodied by WS Gilbert in HMS Pinafore. When asked later why he had created this character, he said that: ‘it was felt that everyone in England should know something of the navy, and when they found one poor man who knew nothing whatsoever about the navy, they made him First Lord of the Admiralty so that he could find out’. The parody was so apt that he was known as ‘Pinafore Smith’ while at the Admiralty. In Pinafore he sings:
‘… they took me into the partnership. And that junior partnership, I ween, Was the only ship that I ever had seen. But that kind of ship so suited me, That now I am the ruler of the Queen's Navee!’
On the other hand my father, of blessed memory, (an accountant, not a doctor) was told as a young man that a partnership was the worst kind of ship he could ever find himself in.
All of which came to mind when wondering if we are seeing the beginning of the end of general practices run as partnerships in the UK. On page 20, Ding and colleagues have explored how the resurgent numbers of non-partner GPs are faring. The picture this paper paints is that the salaried option may well suit doctors wanting to build a portfolio career, or who need more flexibility. The authors suggest that it provides jobs for doctors who were previously under-utilised.
At the same time, there is concern that the newest generation of trained GPs are only finding salaried jobs to apply for and partnerships are not being offered in substantial numbers. The new contract has produced benefits that might be expected, in terms of increased reward for increased workload, at the expense of some loss of autonomy (page 8). If it turns out to be true that the increased rewards are being unequally shared out, we may be creating unnecessary divisions within our own ranks. Certainly the salaried option has its own problems.
On page 53 Peter Davies describes his lesser feeling of commitment to the practice when he worked as a salaried doctor, and how much better it feels working again as a principal. On page 60 Julia Lecky recounts some fairly hair-raising tales of salaried doctors she has met as an appraiser. There is a reminder of the risks of becoming isolated on page 15, in a study of burnout among Danish GPs. Of all the countries in Europe, Denmark seems to have developed a system of health care closest to the NHS; which, combined with the admirably egalitarian Nordic model of how a society works best, should ensure contented GPs. Unexpectedly, the study found a significant proportion reporting themselves to be burnt out. The risk of burnout was higher among those who were not a member of a continuing medical education group, though the authors acknowledge that they cannot infer any causal relationship.
In the editorial on page 5, Tom O'Dowd emphasises the need to ensure that GPs are not working under excessive stress, but fears that a contented workforce may lose sight of its core values, most importantly as advocates and carers for their suffering patients.
Tom O'Dowd's editorial is a fitting way to mark the end of his membership of the BJGP's editorial board. He, along with Surinder Singh, Blair Smith, and Lindsay Smith are leaving the board after years of invaluable service. All of them have been immensely supportive and given me much needed advice. They leave with my heartfelt thanks. We're replacing them in the course of the next 2 months, and anyone interested in applying should look at the advertisement on page 49.