Biology A level classes in the 1970s often involved frogs making the ultimate sacrifice for the benefit of their dissector’s knowledge of what lies beneath the amphibian skin. As far as I remember, it was not however common practice to test the widely-held belief that a frog in a water bath would tolerate a slowly rising temperature and die from heat exposure before attempting to escape. Dedicated scientists have proved that this is not the case. Hot frogs jump.
Every myth has a core of truth, and amphibians, of course, adapt to their ambient temperature allowing them to hibernate in the near freezing mud at the bottom of a garden pond and bask in the sun on the deck of a duck island with equal sang froid (or chaud).
General practitioners have this amphibian quality in their tolerance of work. Over the course of my career I have seen the work load of general practice intensify. The John Wayne contract has evolved to leave the boundaries of the job perilously ill-defined. A man’s gotta do what a man’s gotta do says little about work-life balance. GPs are the victims of their own ingenuity, altruism, and opportunism. When you run a for-profit small business, you don’t turn down an offer of a new way to make money. Given this basic physiology of general practice, successive governments have found that you can slowly turn the heat up under primary care with very little sign of complaint and almost no evidence of distress. The GPs just seem to be swimming a little faster—seems like a good thing?
Two government initiatives have simultaneously raised the heat in the last few months.
The first is the Health and Social Care Bill which seeks to place unrealistic expectations upon general practitioners who lack the skills, time, and inclination to shoulder the burden of rationing that is the proper duty of the Department of Health and the ministers who raise the taxes that fund the NHS.
The second relates to pensions reform. It is not the rise in pension contributions that will be a problem for GPs, who are well paid and have secure jobs—no, it is the rise in retirement age that is the trouble. The job is exhausting. Meeting a new patient every ten minutes, creating an empathic space in which literally any problem can be presented for consideration, searching for the lethal needle in the symptom haystack and managing the undiagnosable, the incurable, and the insatiable wears a chap out. Let alone running the NHS in your spare time and saving £20 billion while you are at it.
The profession is slowly waking up to the bill which solves none of the problems of the NHS but dumps responsibility as far from politicians as they can throw it. Raising the retirement age to 68 makes an impossible job unsupportable. It is a fatal combination of intensity and duration.
The water is too hot. The frogs will jump.
Peter Bailey is a retired general practitioner, Cambridge