The job of a GP has changed — the system must change with it
The writer is a GP in London
It is often said that primary care is the foundation of the health service and that general practitioners are the bedrock of the NHS. This status comes with privilege and responsibility. Privilege because the NHS remains one of the most comprehensive and fair health systems globally. Responsibility because just over 1m consultations occur every weekday across the country in general practice, providing patients with a safe space to share information about their illnesses, woes and challenges. When they do not know where to seek help, patients turn to general practice. These values are the reasons I became a GP.
However, the job is now far more demanding and stressful than I could have imagined when I first entered a surgery a few years ago. The anxiety and uncertainty with Covid-19 has exacerbated this as interactions with patients have become limited. The nature of general practice is different now.
Expectations have shifted. Many patients want the same healthcare service as they see in banking, retail, transport and hospitality. Instant access and on demand. Why can’t I book an appointment when it is convenient for me? Why can’t I access the doctor when I need it most? Why do I have to go through so many hoops to get a blood test? These desires are valid but there is limited staff and infrastructure to provide this level of service.
The concept and meaning of work is also changing. Among my peers, many are now salaried, or locum, GPs rather than pursuing the traditional route of investing in a practice and becoming a partner and an independent contractor to the NHS, which comes with administrative and human resources responsibilities. As a salaried GP, many see the role as a job like any other — they see their allocated patients, do their jobs and referrals, and then go home. They want flexibility and seek no additional commitment. This makes the role transactional.
Many newly qualified GPs now have a choice of roles and of work patterns that were simply not open to their predecessors. I have seen peers join pharmaceutical companies, work in big tech, become venture capitalists, technology entrepreneurs, social media influencers and still continue to work one or two days as a GP. The concept of a portfolio GP is not new but it is more prominent. The challenge for a practice as an employer is that they must compete with this level of choice for talent. The portfolio work pattern also makes it a challenge for practice management to plan for the number of GPs available to see patients. This is where a multidisciplinary approach can make a huge difference, with nurses, physios and pharmacists all sharing the workload.
Yet, while this approach is imaginative and necessary, the recent media frenzy around access to appointments and whether patients should be seen face to face or virtually has focused on an outdated model. The focus needs to be on reform and what the future of primary care is and should be.
How do we bring more appropriate care to our patients and continue to be safe and effective? How do we build multidisciplinary teams to ensure continuity of care? How do we ensure the use of technology is used effectively and safely? How do we bring diagnostics into the community? There needs to be a model that incentivises change and measures performance, clinical outcomes, quality and safety.
The new generation of GPs need to have a voice in what the future holds for the profession and how primary care is delivered. This should be done through engagement with the organisations that represent them in order to demonstrate what is possible. If primary care is to remain a foundation of our health system, modernisation is needed. Both the career and role need to change if newly qualified GPs are to contribute their energy and ideas over the many decades of their working lifetime. The health of Britons demands nothing less.