John Chisholm: We're overworked and close to breaking point

From a speech by the GP committee chairman at the British Medical Association conference, held in Bournemouth
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The Independent Online

All over the United Kingdom, GPs are facing a daily struggle to give their patients the high quality care they need while coping with a stream of Government initiatives and woefully insufficient resources. The current situation cannot continue.

All over the United Kingdom, GPs are facing a daily struggle to give their patients the high quality care they need while coping with a stream of Government initiatives and woefully insufficient resources. The current situation cannot continue.

That is why we decided to ballot all general practitioners in career posts to ask whether they would be prepared to consider resigning from their current contracts in a year's time if a satisfactory new GP contract had not been negotiated between the General Practitioners Committee and the Government, and if the GPC's right to negotiate at a national level on behalf of every GP in the UK was not recognised, guaranteed and safeguarded. That is why we asked all non-principal general practitioners if they would be prepared to support their colleagues who are principals. We asked GPs fundamental questions about their future and the future of general practice.

The responses could not have demonstrated more clearly and loudly the unity of purpose in the profession. Of those principals who responded, 86 per cent said that they would indeed be prepared to consider resigning – an absolute majority of UK principals. Ninety two per cent of voting non-principals said that they would support their principal colleagues.

The problems of general practice include poor morale and the recruitment and retention crisis. The UK is seriously underdoctored. The information available provides an appalling indictment of successive Governments' neglect of the fundamental problems facing general practice. Those Governments have, indeed, not just failed to address those problems but helped to create them. General practice has suffered from decades of neglect and underfunding.

But the fundamental issue for GPs – the issue that has caused the explosion of GP anger in recent months – is workload. The constantly expanding job description; the unresourced and unplanned shift of workload from secondary to primary care; increasing patient expectations; the increasing complexity of the work we do; the implementation of National Service Frameworks; increased bureaucracy; the limited scope for delegation; the conflict between continuity and accessibility; all these factors are putting unsustainable pressure on GPs.

I know that GPs throughout the country are overburdened with work to the point where many of them feel they cannot go on. The complacent shovelling of more and more work onto GPs, the use of general practice as a dumping ground, without giving the profession the numbers needed to carry it out, has to stop. GPs have had enough. They can take no more. They are at breaking point.

In order to attract and keep the GPs we need, we require more than incentives at the start and end of a GP's career. Solving the workforce crisis is a question of how GPs are valued throughout their career, how the job is perceived, and how GPs feel about the job. We also need recognition that the timescale for implementation of the NHS Plan is undeliverable – that expectations cannot be realised unless more GPs are recruited and retained.

The present arrangements under which most GPs contract to provide medical services are failing both GPs and – more importantly – our patients. Both the Government and GPs believe our contract needs modernising to encourage high quality services, sensitive to local needs. We need to reduce bureaucracy, to have a contract based on quality rather than primarily on the numbers of patients on a GP's list, and to see vastly more investment in the infrastructure of general practice, including support staff. We also need a commitment and a role that are better defined and less open-ended.

I am grateful to GPs for their support. Our strength lies in our unity. We need to secure a better future for our profession and our patients. Family doctors and our patients deserve nothing less.

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