Patients need to know GPs pump the life blood of the NHS

Dr Kas Hawes shares why she has written a book for patients about the life and challenges of being a GP

I first conceived of writing a book about work for my children when they were young; an explanation for my absence, distraction, or exhaustion after a day of work with exam study occupying my evening ahead. It was only years later, when my youngest went to school, that life afforded me the time. This coincided with a time when understanding our work seemed essential to the general population, national media, and politicians who have put us on trial without evidence for years.

Now, more than ever, is the time to introduce a more positive discourse about general practice. GPs around the country are engaging in collective action to tell the Government that something must change. For general practice to survive, there has to be a shift – less box-ticking, less administrative work, and better funding. The only way this can happen is through a better understanding of what we do daily and recognition that we, rather than politicians, know what works at the coalface.

In my book The Heart of the Matter: A Day in the Life of a GP, I dispel the long-standing mystique and open the doors to the reality of life on the frontline. Presented as a single day, measured in minutes from wake to sleep, I aim to capture the stress of keeping up, relinquishing one patient and problem to the next without a break for hours at a time. Each call or knock might be straightforward, but each is a person, someone’s family member, putting their lives in our hands. There is no time for daydreaming. No one deserves less than our human best. Our job is amazingly rewarding. The fear of getting it wrong can be terrifying.

Though the book has been put on recommended reading lists for medical students, I wrote it for the public – so they can try and understand what we do. While it is a personal account, it is not my story. It is the story of all the patients I see in one day, a tale of myriad problems. People from all walks of life reveal the harsh reality of their lives and the tribulations they face. I attempt to describe the privilege of our job, the enormity of responsibility when we step in to help. I also include information about common health conditions and my rants about the need to curb antibiotic use. These messages promote knowledge that improves understanding of health and the rationale of our decision-making. If the public knows that we care, I hope it will increase the patience of our patients.

Sometimes our patients make us smile; other times they make us sad. And sometimes they can make us frustrated; with their choices, attitudes, or the social injustices they face. Working in a deprived area for 17 years, that is a familiar feeling. I didn’t intend to stay in one place so long, but found the joy of general practice in the team I work with and the generations of families I’ve come to know. Though it is hard to maintain continuity now, we meet again over the years and reconnect. I feel tied to this population, settled in the semi-rural, ex-mining area within the top 10% most deprived in the country. Sadly, the loss of this patient connection and continuity has triggered the departure of many GPs and upset for some of our patients.

Our population is divided. The privileged and the poor. The north and the south. Some appreciate the NHS and believe in resilience and responsibility for their health. Others, having never known anything but free healthcare, expect us to fix their problems, either unwilling or unequipped to help themselves.

As we already know, a key to that division is deprivation. Childhood poverty – poor education, lack of aspiration, and the crutches of hardship like alcohol, drugs, smoking, and cheap unhealthy food – creates a societal box that’s almost impossible to escape. It’s easier to criticise than empathise with this reality, but it solidifies into ill health, hardening arteries, contributing to cancer, and reducing resilience. With this book, I hope to stimulate consideration for patients: where would I be if I had walked in those shoes?

There are no easy fixes – not for individuals with complex health problems, nor general practice. I am an average GP without the answers, and the road ahead is unclear. How do we make change without damaging patient care? How do we protect our workforce who hold the foundations of the NHS in their hands? Knowing how we work as a team, what we do, and what we worry about, I hope, will help. There are hard times ahead, hard questions to answer but I firmly believe that improving understanding is the way to more positive change. I also firmly believe that, as a group, GPs have the collective will to find a way. 

I believe that this is the ‘heart of the matter’. General practice lies at the centre of the health system. We are the unceasing engine pumping the life blood of the NHS. This story, our daily journey, is at the heart of every GP working in the UK today whether they are at a point in their career when they are struggling to keep their heads above water, as I have in the past, or able to enjoy the way that its challenge can nourish our humanity. It is not intended as a book of complaint; I am incredibly fortunate to live a fulfilling life. It is a book of honesty, a diary of the single day of a doctor stripped to the minute, exposing every thought, hoping to provide new insight and with it, understanding.

Dr Kas Hawes is a GP in the Northeast of England and the author of The Heart of the Matter: A Day in the Life of a GP.