Samir Dawlatly: Open letter to the Department of Health and NHS England

Dear Department of Health and NHS England

It seems clear that you, the medical fraternity, as well as the mass media agree that there is a recruitment and retention crisis in general practice in England. What is also clear is that we have differing opinions on the reasons this crisis has arisen.

While doctors and some of the organisations that represent us are open about working conditions in the hope that they can be improved, it appears that you are intent on sticking to the same, seemingly rehearsed, lines. Whether the audience is a room full of GPs, medical students, or a national newspaper, the message seems to be: “The reason for the GP recruitment crisis is that GPs complain so loudly about their conditions, putting off medical students and junior doctors—if they didn’t complain so much we could recruit more GPs.” I paraphrase, of course.

Even if that was true, it would only solve half the problem. If all the GPs swore a solemn oath to never utter how difficult their job is and how the difficulties seem to increase year on year, it may, just may, possibly, lead to more junior doctors choosing general practice as a specialty. But even if recruitment to a sugar coated profession was possible, keeping quiet about any issues would not help with the retention issues of GPs taking early retirement, emigrating, or changing profession. And what’s more, many medical students get a chance to see for themselves what general practice is like firsthand as part of undergraduate or postgraduate training.

For example, I was recently struck by the perceptiveness of a medical student who I supervised for a placement and who, despite being honest at the start of the placement that she didn’t want to be a GP, nevertheless performed well. At the end of her placement she told me that she was more sure than ever that she couldn’t be a GP.

She felt that to be a GP one needed to be more driven and committed to patients than she could ever be. She felt that the expectations of “stressed out” patients was just too high, and too difficult to deal with in 10 minute chunks of time. She had noticed that there were additional pressures put onto GPs, so that they spent their whole days constantly working just to try to get things done. In her own words, “That’s not just a recipe for burnout, but that would cause mental illness. I couldn’t do this every day of the week.”

I have no doubts that she would have made a good GP, but she had the insight to see that general practice, as it currently stands, was not a career option for her.

Not complaining about problems doesn’t make problems go away. If I buy my children shoes in haste that don’t really fit them, and they then complain about the pain they are in, the solution to the situation is not to tell them to stop complaining about their discomfort; that won’t solve the problem. I need to find them shoes that do fit, or remove the shoes from their poor little feet.

Raising issues demonstrates an integrity and willingness to tackle concerns that compromise patient care and/or doctor wellbeing. So instead of flogging the profession in the hope that it will boost morale, it may be worth actually listening to general practitioners.

For a start, why not recognise and deal with the tight, blistering constrictions of the huge amount of over-regulation we face: the Quality and Outcomes Framework, the Care Quality Commission, clinical commissioning group schemes, Directed Enhanced Services, traffic light ratings on cancer referrals, and the family and friends tests, to name a few. It would also help to acknowledge that GPs are facing rising demand from a health anxious, risk averse, increasingly complicated, and older population, where more healthcare is expected to take place outside of the hospital setting.

Surely the best advert for general practice would be general practitioners who felt valued?

Can you not work with us to help us feel valued? One step towards that could be an understanding with your press departments that national newspapers could be used to promote a positive reflection of what GPs achieve, day in and day out. This would make a change from the often unfounded and ostensibly systematic belittling of the foundation of the NHS.

Whether you heed this advice depends, of course, on whether your respective organisations actually want a vibrant, resilient, functional, and efficient general practice workforce as the foundation of a centrally funded national health service?

Samir Dawlatly is a GP partner at Jiggins Lane Surgery in Birmingham. He combines clinical practice with being a part time house husband and an interest in social media, as well as publishing poems, essays, and blogs. He can be found on Twitter as @sdawlatly.

I have read and understood BMJ policy on declaration of interests and declare the following interests: I am a member of the RCGP online working group on overdiagnosis.