Is the system really ‘broken’? 

Dr Margaret Ikpoh on the importance of the language used to describe general practice, and the danger of a single narrative

At the RCGP annual conference this year, the health secretary referred to our NHS as being ‘broken’ and to the Government’s pledge ‘to bulldoze bureaucracy.’ Before I could dust off my hard hat, the BMA published their vision on why general practice is broken soon after.

To be fair, I did require safety gear this week but not in the physical sense. Successive weeks of IT failures and the stress of extended days to ensure timely updates to patient records has been mentally taxing. As always, our teams showed remarkable adaptability which underscores our capacity to respond to changing circumstances (Covid being a great example historically.)

So, the ongoing narrative that the system is ‘broken’ oversimplifies a complex reality and risks undermining the essential role we play in patient care.

While it is crucial to acknowledge and address the challenges facing general practice – such as workforce, workload, rising patient expectations and poor estates – framing the entire system as ‘broken’ is counterproductive. Such language can demoralise healthcare professionals and erode public trust in the system.

Nigerian novelist Chimamanda Adichie describes the danger of a single story. She suggests that hearing only a single story about another person, country or issue risks a critical misunderstanding. In our case then, to show a profession as one thing (broken) repeatedly, is essentially what we become. The power of language is important in shaping perceptions and influencing public discourse.

I am in no way trying to sugarcoat our reality. But a balanced narrative that recognises both the strengths and areas for improvement is essential. This approach encourages constructive dialogue and collaborative problem-solving, fostering a more supportive environment for GPs and patients alike.

We can choose words that either polarise or unite; stigmatise or empower. Terms like ‘broken’ can create a sense of hopelessness, inevitability and a lack of public confidence discouraging efforts to seek solutions. Conversely, thoughtful language that acknowledges challenges while highlighting resilience and potential for improvement can inspire action and optimism.

General practice faces significant challenges, but it is far from broken. By recognising our strengths, addressing our weaknesses constructively, and using language that promotes positive change, we can ensure that we continue to thrive and safeguard patient safety.

If anything is broken it’s the broken record from successive governments that have failed to ensure that general practice remains the cornerstone of healthcare which is best placed to meet the demands of our growing population. This can only happen with appropriate resources, adequate workforce and an evolving will with key stakeholders to address this – so how about we fix that first?

Dr Margaret Ikpoh is a GP in Holderness, East Yorkshire. You can find her on X (formerly know as Twitter) @docmagsy