Dr Katie Musgrave explores why so many GPs are reducing their NHS clinical sessions, and what needs to be done to better support them
When I started GP training, I worked full time. Between spells of maternity leave, I was working 3 or 4 days a week. Once qualified, I knew I’d only be able to manage two clinical days a week (the demands of a qualified GP being that much greater.) Coming up to four years since qualifying, I have now reduced my NHS clinical sessions to one day a week.
Being a GP in the NHS can feel like being in an abusive relationship. It’s bad for us, often thankless, and hard to escape. We are chained to our desks for 10-12 hours (or more) a day, making life or death decisions on the fly, and then carrying the emotional burden home with us. We don’t exercise, we eat lunch at our desk, and we frequently don’t drink enough. Our wider relationships suffer. We feel guilty for the quality of care we should be delivering, but can’t.
Years later, these hazardous conditions we’ve worked under will undoubtedly result in lawsuits, and we’ll be blamed for systemic failings. But, we apologise and continue to defend our abuser, despite the mounting evidence of their inadequacies. We somehow feel trapped – how would they cope without us?
It is important to acknowledge that GPs in the UK are now routinely dealing with entirely unmanageable workloads. Every survey we see delivers the same message: we are stressed, overworked, miserable. No wonder so many of us are planning to leave. With many younger GPs already taking this approach, I will not hesitate to leave the NHS entirely, or emigrate to work in warmer climes if the situation gets worse. This job is unsustainable and I will not spend my life slaving away in a broken system if it’s hurting me or my family.
If the health system doesn’t start to recognise these growing trends – and consequently do something about it fast – the NHS will face disaster. Every GP I know under the age of 40 has an exit strategy. They are diversifying, applying to work overseas, moving into the private sector, working in digital start-ups, education, academia, or developing a special interest. Almost nobody has the intention of full time clinical work as a GP. And who can blame them?
It is appalling that we have normalised working conditions so dire that almost no GP can cope with clinical work for more than 4 days a week. If an alien were to land from outer space, they would ask why we don’t all work a bit less intensely, so that we could manage an extra day (or at least not burn out). Our hours are not family friendly, and put an immense pressure on parents of young children, who need to leave at a reliable time. A reduction in intensity, and an increased flexibility, would surely help stem the exodus of GPs leaving the profession.
The retainer scheme is a good step – offering practices support and incentives to provide more flexible roles. This shouldn’t be limited to just those with caring responsibilities. Every GP should be supported to have a manageable workload. The scheme could be rolled out to cover every salaried GP post – with financial incentives for practices to protect GPs’ workload, provide mentorship, and educational time. GP partners should be offered similar protection – there needs to be some form of appointment cap, and options for excess demand to be diverted elsewhere.
General practice has to change. The system has to treat GPs as humans: with needs, limitations, responsibilities, and personal lives. The NHS cannot afford to oversee the continued exodus of its qualified GPs. It is a disaster for the health service as a whole – which is leading to a downward spiral of dysfunction, worsening health outcomes and inefficiencies.
I’m sorry to write yet another bleak piece. But make no mistake, if the system doesn’t change, GPs are in genuine danger of extinction. They’ll miss us when we’re gone.
Dr Katie Musgrave is a GP in Devon
I have to say I’m shocked that one day a week is the maximum sustainable in GP. I’m assuming that other commitments fill the rest of the week and are easier (or more profitable) but still don’t allow one to work maybe two or three days a week. I’m ready for the flack on this one but really don’t understand it. Maybe it’s me, maybe I work in a very different practice with very different patients. It’s a tough job, I get that but it pays well (£s/hr is still pretty good for part-time working) can be rewarding but also tedious. Where did it all go wrong and what happened to ‘resilience’? GP of 30+ years, mostly full time – Male, Pale and Stale, or so I thought – is it that I had a different outlook or just tolerated more. Did I miss something? (No, REALLY – I don’t understand – so rather than biting back – do that if you have to, please explain.)
This was my experience and I’m glad to have retired. My solution would be to employ assistants responsible for pathology and medicines management for the list held by a GP. Lists should be capped to eg 225 pts per session worked and personal lists should be utilised for appointment requests and oversight. Only those documents and results generated by consultations are communicated back, the rest dealt with elsewhere in the system. Needs other specialist HPs to help process all this and give GPs back the job of acting as consultants in complex primary care management but not chronic disease management.
My wife approached a practice who said they would entertain her as part of the retainer scheme, they didn’t know what it entailed and after she explained it to them they ghosted her.
This was also my experience. I worked my but off as a junior in hospitals in the days when HOs were still doing the entire weekend on call and you were still expected to turn up for work on Monday – I’m no flake. The idea this has something to do with a generational reduction in “resilience” is completely incorrect and to me suggest a degree of wilful ignorance and/or failure to out enough. General Practice is completely screwed and it’s absolutely not because today’s GPs aren’t manly enough…and I say that as a man, who is pale but wont be stale until I’m dead..thank you
I’m down to 2 days a week (4 full sessions 8am-730pm) plus the inevitable “unpaid” admin day (= day 3, at home), and have at last found a balance that works. I can only do that by having retired early to fund it. But I’m enjoying GP again and might stay a bit longer. I guess it depends how much the Tories, The CQC, and NHS-E piss me off in the meantime. It will be a low threshold. Having done 25 years of 9 sessions a week can I say to those that take “worry” home, you won’t survive to retirement. Develop a sense for things that could go tits-up, look after that stuff very carefully, and manage the backlog of things that can wait. And at the end of the day, remember that’s why you’re insured, that’s your safety net, Be kind to patients, don’t annoy them, and they’ll be on your side if things go wrong. And always say sorry and mean it.
I’m usually pretty much in agreement with Dr Musgrave’s articles – but as per Dr Aras’s comment, I find Katie’s opening paragraph astounding.
4 years after qualifying only one day per week can be tolerated. Dr Aras will not get an explanation for his non-understanding, it is incomprehensible.
I am an older GP, and I am leaving the NHS to work in a different system, precisely because of the reasons you outlined, and more. I don’t want to take any more flak and disrespect from patients and the system, and I don’t want to work anymore in a system so blinkered by its own bureaucratic rules that it doesn’t enable people who want to go forward to do so.
Heres an explanation to those who just dont get it – a tremendous variation in the experience of clinical practice from one area to another. You find this out as a locum. It is due largely to demographics and the characteristics of the practice population. Some of its also down to variations in administration. In some places things are almost ok, other places feel like hell on earth. Add to that the enormous change that has occurred in the last few years in presentation rates and peoples expectations. In some practices (I’ve worked in them) you can find a bunch of partners who have been practicing comfortably for many years in the same place. They have it all set up exactly as they want, they have a sub group of dedicated patients who love to see them and all the ones that don’t, learned long ago to avoid them like the plague. The annoyingly confusing random intensive new registrations don’t get booked in with the special Dr (he/she is ‘too busy’) they get stuck in with the salaried instead. As the one running the show, in some lucky places, I can quite imagine this might be a relatively comfortable situation. The salaried staff they employ are younger and bafflingly “less resilient”. So yes the well established comfortable partner might be relatively unaware of the utter shit show going down in their less experienced, more recently qualified salaried colleagues surgery. Who also get to do the visits and the random crap.. because reception don’t want to bother Dr big balls. It isn’t like this everywhere, lots of places don’t operate like this ..but its definitely like this in some. So if you cant get your head around why someone new to the game (or just anyone who isn’t ‘in control’) is exhausted, it doesn’t mean its unexplainable, more likely you’re fortunate enough to be comfortably shielded by location/experience/position from the reality of everyone else’s shit tsunami.
Happy to write the alternative anrticke/argument wrt GP – it’s a GREAT job and done right can be very rewarding albeit it’s tough – but what job isn’t?
“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”
LT, what about s/he who doesn’t go into medicine, reads the odd book but happily sails the seven seas? Where does s/he fit in, in all of this? 😉
The vast majority of GPS I know have indeed decreased sessions to the minimum they can manage. Full time is now 6 sessions and soon to drop further with the complexity of what we are expected to manage and the lack of time and funding to do it.
@STBFA – yes there are a few pirates out there!
@STBFA – just re-read your question, I might have missed the gist of it yesterday – my answer would be that all willing and able crew-members are welcome aboard – the ship’s taking in water – we need all hands on deck!
Liam I quite liked your pirate idea, ooh-arrr me hearties