Dr Burnt Out: The first weeks of August will determine the profession’s future

With impending industrial action and the influx of newly qualified GPs into a nearly non-existent job market, Dr Burnt Out discusses the importance of August for the future of general practice

The first two weeks of August are going to be interesting.

Firstly, it is looking like thousands of newly qualified GPs will find that there are no jobs for them. This could, and should, be headline news and, if correctly termed, a ‘scandal.’ If what the BMA predicts in terms of possible GP unemployment is remotely true, then it is a time for some serious soul-searching and apologies by all manner of GP and NHS bodies.

It will be a profound betrayal of young, newly qualified GPs, who have had to train for many years, doing many rigorous and expensive exams – only to find that they are unemployed and have been replaced by cheaper and less qualified non-medical staff. I hear many are already emigrating or leaving the NHS entirely. This situation is, as far as I am aware, unprecedented, so all bets are off as to how it will pan out.

Secondly, early August is the proposed date of BMA led industrial action. But let’s face it; it will be voted through and it will happen, with various selections from the ‘menu’ of options that the BMA has devised (I’ll have the steak please, medium rare, followed by the crème brûlée.) 

This step is understandable. The behaviour of primary care leaders at NHS England (GPs themselves mainly) is inexplicable: Why not include GPs in ARRS funding? Why not transfer the ARRS funding into core funding? Why continue to promote and ingrain ARRS staff when clearly most of the public want to see GPs? Why tolerate and not speak out about unemployment amongst your own fellow GP colleagues?

It is almost as if NHSE England has hunkered down into non-listening mode, gone out on the razzle, ended up in a dodgy nightclub, had one too many Carlsberg Special brews, got beaten up (or possibly beaten someone else up) and then come home in the early hours singing My Way (the Sid Vicious version) from the top of the stairs, before slamming the bedroom door shut in a fit of rage. (Incidentally, I would rate the Sid Vicious version of My Way joint best hit single of 1978 along with ABBA’s Take a Chance on Me).

With industrial action, unlike newly qualified GP unemployment, there is both national and international precedent. The junior doctor strikes have been well documented and debated, and still seem far from resolution. The latest round of strikes concluded only this week. Junior doctors are also threatening winter strikes if a new government rejects the 35% pay rise.

Don’t get me wrong – I support the junior doctors bar one thing: Strikes rarely work. And they definitely don’t work if the general public is not on your side. What usually works is skilled and extremely tactical and clever negotiation.

One example of this is the current South Korean Doctors’ Strike. This has been ongoing since February, when doctors expressed dissatisfaction with the announcement of new government policies significantly increasing medical student quotas. The 11,994 striking doctors (who make up 93% of the trainee workforce) claim the recruitment of 2000 extra trainees a year will compromise the quality of services. Instead, they have called for improvements to pay and conditions.

However, the situation has now descended into considerable acrimony. The South Korean government has started taking steps to suspend the medical licences of thousands of the striking doctors. Neither the public nor the media seem to be on the doctors’ side, with an editorial in a national paper saying: ‘People’s patience is wearing thin…the exit from this quagmire must be found between dialogue between the two sides.’

Furthermore, a poll by the Yonhap news agency found that 84% of the public supported the government stance of hiring more doctors, and 43% thought that the striking doctors should receive severe punishments. So, it is safe to say that the strikes in South Korea do not seem to be working. 

Back to the first few weeks of August: this could be the start of an especially tumultuous time in general practice. We will see how industrial action pans out. I am, however, more concerned about the future of a profession where huge numbers of newly qualified GPs cannot find a job. It almost seems to call into question the longevity of doctors becoming GPs as a long-term career option: will GPs even exist in a few years? This seems the pertinent and terrifying question that we now have before us.