Those of us fed on a diet of cheap Hollywood box-office hits will be familiar with the term ‘mission creep’ to refer to the gradual shift in objectives during a military campaign.
But I recently heard the related business term ‘scope creep’ and I was struck by how this more or less sums up the GP contract.
This analogy refers to uncontrolled changes or continuous growth in a project’s scope and occurs when the scope is not defined, documented or controlled. Sound familiar?
No-one really knows what is in our core contract. Without this objective defined, the piling of more work onto GPs has become a strategy to manage the financial deficit. Patients who would have previously been hospitalised for two weeks are now admitted for day-case surgery. Those who would have been followed up in outpatients for several years are now discharged after their first visit and GPs pick up the pieces.
In the last 20 years, the work of a GP has changed beyond recognition. We have become the new general medics, elderly care physicians, providers of complex wound care and house officers to hospital consultants, to name but a few. And while doing this we have also been expected to reduce elective referrals and unscheduled admissions.
Gone are the days when patients who had suffered an MI or a stroke were advised bed rest and to hope for the best. We now have an entire pharmacy to play with. And waiting for patients to become ill and come to us is no longer good enough. We are forced to pro-actively find more cases of dementia, diabetes and hypertension and then to drag them kicking and screaming into the surgery for treatment.
So why have we sat back and allowed this to happen? The main reason is because we are too nice.
We prescribe for the UTI because the consultant didn’t have an FP10 pad in their community clinic. We request pre-operative investigations because we want to save the patient another trip to the hospital. We take on the prescribing and monitoring of the growing number of shared-care drugs because we are asked to, and we do not question performing the tasks of other health professionals who claim a lack of capacity as their reason for not doing them. In short, we are the world’s largest toilet that allows any number of dumps on our doorstep.
If we were train drivers or teachers, we would have the backing of a strong union who would be fighting against this insidious drip-feed. Instead, we have the BMA, which seems to have forgotten about inflation when benchmarking for private fees. Imagine being able to notarise documents through a solicitor for only £15 instead of the £75 my husband recently paid.
The reality is that no-one has got our back. Workload is mushrooming and income is dwindling. The only way to survive is to set boundaries ourselves and say ‘no’ to anything we are not contractually obliged to do.
Dr Shaba Nabi is a GP trainer in Bristol.
