Not ‘coasting’, but drowning Wes

Katie Musgrave offers the health secretary insight into the reality of general practice following his comments that some GPs are ‘coasting’

I contemplated entitling this blog ‘Stupid things Wes Streeting has said’, but thought better of it. After all, that would be rude and disrespectful. But it might not be half as rude and disrespectful as implying that a proportion of a hugely dedicated, unappreciated, and frankly desperate workforce were idle and fleecing the system. In case you missed it, I am writing about Wes Streeting’s comments suggesting there are GPs and practices ‘who are coasting at the expense of those who are striving hard’. Given the current conditions in the NHS, what kind of health secretary would possibly consider – even go near – making such an ill-considered and offensive statement? Has he ANY idea what it’s like out here?

But back to the ‘coasting’ GPs. The issue isn’t so much the insult, but rather the sentiment behind. It reveals the utter contempt the health secretary holds for general practitioners and his clear refusal to believe or engage with the crisis that we face; in our workforce, workload, the dysfunctional interactions we have with secondary care, and the insecurity around longer term funding and estates. Quite clearly in Streeting’s mind there are some GPs who have pulled themselves up by their bootstraps and are doing the fine work the NHS needs, and there are some of us lounging around and having an easy ride. 

I’ve worked at dozens of GP practices now. I have friends who work at dozens of other surgeries. Believe us when we tell you Wes, there are no coasting NHS GPs or surgeries. As an instinctively lazy person, I promise you if there were, I’d be working there! In my experience – and I’m absolutely certain in the experience of every other GP you ask on this topic – there are only different shades of stress, overwork and despair amongst us. Perhaps you might care to find this enigmatic coasting GP, so the rest of us could follow in their footsteps? 

If you prefer not to believe our protestations, then it is high time you looked more carefully at the research on this topic. A 2023 Health Foundation report analysed data from the Commonwealth Fund, looking at a survey of over 9,000 GPs in 10 high-income countries, including over 1,000 in the UK. The UK GPs reported higher levels of emotional distress and bigger rises in workload than GPs in nearly all other countries, with many considering leaving the profession altogether. 71% of UK GPs found their job ‘extremely’ or ‘very stressful’, which was the highest of the ten countries surveyed alongside Germany. 

An RCGP survey of 2,000 GPs last year found that over 40% of GPs are unlikely to be working in general practice in five years’ time, with more than half (51%) of GPs reporting finding the job too stressful as a key reason for considering leaving. If you don’t believe the surveys (after all a lot of people will moan about their jobs without taking any action), then it is worth reflecting on the data analysed by the Institute for Government which showed that more than one in five GPs under the age of 30 quit the profession in the 12 months leading up to December 2022. 

Still the most common reaction to our poor working conditions and unsustainable workloads is to reduce our clinical sessions, in order to protect ourselves from burnout. The King’s Fund found that less than a third of GP trainees intended to work full time upon qualifying, with most feeling that five to six clinical sessions was about right. Predictably the top reasons for not wanting to work full-time related to workload issues: including the intensity of the working day, volume of administrative work, work-related stress and long working hours. Anyway, who needs reports and data – when Streeting and Starmer have the hunch that we are coasting?

I dearly hope that by the time this blog comes to print Streeting has issued a grovelling and heartfelt apology. But far more than slick words – we need action. We need a government and health secretary who are willing to make harder decisions about our health service, and admit that all is really, really not well. The stack of cards that is the NHS is getting perilously close to collapse; and if I were you Wes, I really wouldn’t fancy clearing up the mess. We’ll see who is coasting then…

Dr Katie Musgrave is a GP in Devon