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Endangered species

Still practising

Chris Preece

Thursday, 16 May 2019

A recent BBC Panorama documentary cast a spotlight onto the national shortage of GPs. Sadly, the news cycle being what it is, I can’t help the suspicion that in a couple of weeks everyone will have moved on from reporting on it, with little having changed. So, to this end, can I suggest another fine BBC institution take a look at the subject? 


Country_AdobeStock_175357105.jpgWe open on a sprawling high definition vista – a view of the English countryside. The camera starts high then dips low and fast over fields and valleys, before following a river through a gorge, popping back up to the shock of cars passing a motorway overhead. It whips round to follow them through the city as David Attenborough begins his voiceover:

Attenborough (v/o):

Over nearly 40 years we have detailed the lives of all the major groups of terrestrial animals and plants. So now it’s time to turn that camera back, and look at that most dominant of all species. The human.

Title screen: LIFE, AS WE KNOW IT

The camera settles now on a small inner city GP surgery, and we follow a young family as they arrive for an appointment.

Attenborough (v/o):

GP_AdobeStock_91502692.jpgPart of the unique success of the human species is its ability to care for itself, identifying and treating disease, and taking steps to prolong life. In some parts of the world, central to this process is a very specific type of doctor… The General Practitioner, or GP.

The footage shows a tired but smiling doctor welcoming the family into the consultation room. After a brief conversation, she starts to examine the child.

Attenborough (v/o):

The vast majority of sick humans will visit a GP as their first port of call – with 307 million attending in one year, compared with 24 million visiting their more glamorous counterpart, the Emergency Doctor. Yet, this seemingly enormous statistic conceals a sad truth, for the humble GP is increasingly endangered.

Cut to: Footage of a GP hanging up their stethoscope, and walking away from the practice.

Attenborough (v/o)

Indeed, the number of GPs has fallen from 43,600 in 2014, to 42,100 in 2018. This, combined with a rising population means that there are now just 60 GPs per 100,000 humans, compared to 67 just 10 years ago. This is despite a Government breeding programme that was supposed to deliver an additional 5,000 GPs by 2020. This vital member of the species is rapidly diminishing, and as its numbers dwindle, so the workload increases, accelerating the decline. GPs now see an average of 41 patients a day – above the 30 considered safe, with 1 in 10 seeing 60 or more.

Cut to: Footage of a heaving waiting room, full of increasingly impatient patients, the camera zooms along to a consulting room. Inside we see another GP consulting with a patient. As she talks a phone starts ringing.

Attenborough (v/o):

GP with phone_AdobeStock_202677345.jpgHere’s an example in the wild. This is Sue, a GP in the frosty wastelands of North London. She’s currently trying to persuade her patient to accept an admission to a psychiatric unit. However, that’s the third time her phone has rung, and she feels like she can’t ignore it any longer. With trepidation she picks up the receiver, and is informed that the estranged daughter of a woman she visited earlier that day is insisting she speak to her immediately as she believes her mother requires further attention without delay. Meanwhile, that flashing box on her computer screen is to tell her that a child has just collapsed in reception.

As she talks frantically on the phone her patient gets up to leave - she implores them to stay, only to be distracted by the sounds of someone becoming increasingly animated on the other end of the phone. Three further messages pop up on her screen. It is all rendered in slo-mo.

Attenborough (v/o):

In an extraordinary moment, our cameraman was able to capture the exact second that Sue realises that she simply can’t do this anymore.

Cut to: Manipulatively emotive footage of Sue sitting, head in hands, quietly weeping whilst the camera pans to a photo of her family behind her.

Attenborough (v/o) (with supporting montage):

Of course, beyond the simple issue of workload many other reasons have been suggested for this apparent crisis in GP numbers. Some, it has been suggested, are leaving the profession early because of pension caps. Others, whilst not leaving wholesale, have reduced to part time working – although this may still involve many more hours than the traditional 40-hour week. There is, however, some evidence that even those new to the GP life are choosing to change direction, with one in three not taking up an NHS GP position after training.

This is a situation worsened by public perceptions of this vital sub-species, for whilst the GPs are almost unique in having to be able to manage absolutely any medical condition, often in positions where there is little or no immediate support, they are often held in lower status amongst their tribe than those dealing with small specialised areas with a vast team and the latest technology to support them. Indeed, even the GPs themselves seem to have succumbed to this view, electing to solve the shortage by finding replacements for themselves amongst pharmacists and physiotherapists, seemingly unaware that these jobs, whilst vital, are very much distinct from their own. GPs seem peculiarly prepared to engineer their own extinction.

It is perhaps, the greatest irony, that until now, it has been the General Practitioner that has absorbed work where others have refused it. When patients are rushed out of hospital beds, community teams are cut, or social care is withdrawn, it is the GP that has had to take up the slack. Which leaves the difficult question of who will do this when they are gone? We have failed to support this dying breed, yet have no plans for how we will survive without them.

Cut to: Footage of the original GP, still talking with the smiling family.

Attenborough (v/o)

For now, though, we can continue to enjoy the sight of this extraordinary doctor at work, that rare thing, the specialist in people. We can only hope that, together, we can find a way to save this rare species, before it is gone forever.

Author's Image

Chris Preece

Chris has worked as a GP Partner in North Yorkshire since 2004, and still relishes the peculiar challenge of never quite knowing what the next person through the door is going to present with. He was the chair of his local Practice Based Commissioning Group, and when this evolved into a CCG he joined the Governing Body, ultimately leaving in April 2015. He continues to work with the CCG in an advisory capacity. When not being consumed by all things medical, Chris occupies himself by writing, gaming, and indulging the whims of his children. He has previously written and performed in a number of pantomimes and occupied the fourth plinth in Trafalgar Square. Tragically, his patients no longer tell him he looks too young to be a doctor.
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