An Open Letter to Nick Clegg 5/3/16.
GP Survival member Shaba Nabi responds, to this factually incorrect Evening Standard piece:
5th March 2016
Dear Mr Clegg,
I am writing as a member of the GP group GP Survival: with reference to a recent article published in the Evening Standard which outlines your views on mental health.
Firstly, I would like to say how much GPs welcome mental health issues being at the forefront of the minds of politicians. It is definitely the “Cinderella” area of healthcare and leads to significant ill health, unemployment and social breakdown within communities. We also welcome any increase in funding to provide vital child and adult mental health services.
However, we are puzzled and disturbed by the following statement within this article:
The second is the training given to teachers and GPs. Extraordinarily, neither are trained to spot and respond to mental health problems as part of their qualifications. It is crucial that people who look after people’s wider welfare — teachers and GPs especially — should be given the training to act and refer someone to a specialist before things get worse.
A UK qualified GP will have had many episodes of training in psychiatry. After a minimum five-year degree, which includes mandatory psychiatry training, all newly qualified doctors are then committed to a two year Foundation Programme. Junior Doctors then move on to GP Training, which lasts for three years. Within my local GP training scheme, 22 out of a total of 40 rotations provide a job in psychiatry, which means over half of GP Trainees experience specialist psychiatric training. The remainder will have either experienced it at the Foundation stage or will receive extensive training within their GP Placements.
A significant part of the GP curriculum is entirely based on the care of people with mental health problems.
In a recent NHS England Statement, Dr Ed Mitchell wrote that more than 1/3 of GP consultations are related to mental health. This illustrates the level of experience each and every GP will have with managing mental health issues.
The main challenge for GPs is not that they are not trained or competent enough to deal with the issues; it is the fact that, along with general practice, mental health and social care services have been so chronically underfunded that there is nowhere we can safely refer these patients to.
It is only those patients in mental health crisis who are able to see a psychiatrist and waiting lists for psychiatric therapies can be over three months long. In the meantime, it is the GP who is left to offer enduring support for the growing number of mental health patients, and their families.
Finally, I would like to draw your attention to the following statement in the article:
A hospital, for example, is paid by activity: each procedure has a price attached to it and the more it performs the more money it gets. Mental health trusts, on the other hand, usually get a block grant. So when demand goes up, the money stays the same.
Ironically, this has been the financial situation for GPs since the inception of the NHS. This flat fee system offers a patient an unlimited supply of GP consultations. The fact that you would be unable to insure a pet for this annual sum speaks volumes about the value of GPs in our current society.
Perhaps instead of making erroneous statements about GPs, you could try and understand what the role of a GP involves in 2016? GP Survival invites you to spend time in a practice so you can experience the immense challenges we face on a daily basis.
In the meantime, we would all respect your politics and views a lot more if you were to write an amendment to the above article to apologise for your ignorance concerning GP Training.
Dr Shaba Nabi
MBBS BSc MRCP MRCGP
Charlotte Keel Medical Practice, Bristol
GP Training Programme Director Bristol
GP Appraiser South Gloucestershire,
Clinical Lead Cardiovascular Disease Bristol CCG
Member GP Survival
An Open Letter to David Cameron 17/2/16
Dear Mr Cameron,
I have been watching the events unfurl in the Junior Doctor contract dispute with a sense of frustration. How a group of highly trained professionals, can be treated with such a degree of contempt, by a secretary of state, is breath-taking.
I am a GP. I manage a team of staff. I also train medical students and junior doctors. Sometimes they are my age or older, have a wealth of life experience and skills that I do not possess. In many ways we are peers, but I am responsible for them and their actions.
Strangely, my job and yours have similarities. We both sit at the top of a pyramid. Our roles involve assessing our team members’ skills and delegating work appropriately. Where there is conflict, we resolve. Where there is doubt and stress, we support. Where there are there are failures we train. But ultimately, when something goes wrong, the buck stops with us.
And this is where we differ: had someone in my charge persisted in making toe-curling errors, misrepresented the facts repeatedly, or soiled relationships with the people we need to work closely with, I would have acted. I would have stepped in, to salvage the situation; save their bacon and mine. I would have calmed the situation, given time for both parties to think and I would have apologised. Where a staff member or trainee was being pig-headed, had made recurrent errors, or had obvious inadequacies, I would have removed, or retrained them.
And so, Mr Cameron, for someone in your position to have failed to do this leaves me confused. You are successful and obviously intelligent. You have been in the ultimate position of responsibility for a long time; I therefore find it hard to believe your capabilities as a manager are at fault. So I am led to question your motives. The only reason I can think of, that you haven’t resolved this dispute yourself, is that you are not only aware of the disgrace that has happened, but you are indeed complicit.
This is, in many ways, far more concerning. You have helped create one of the most despised men in Britain in Jeremy Hunt. You will level the blame for the fall of the NHS at his door, and yet, you are just, if not more, responsible.
Please think on your actions, and consider stepping in to resolve this matter, rather than becoming the mastermind behind the destruction of the National Health Service.
A Concerned GP
Notes from a retired GP
I have just retired having graduated in 1975. I am one of those for whom medicine was the only option, whether this showed lack of imagination or a true vocation I’m not sure. My university tuition was paid by the tax payer and I qualified for a grant. I graduated with no debts. I suppose I always felt an obligation to give something back, although it became clear that many colleagues were not so inhibited and got out to greener pastures asap. Certainly days were long and there was no way to avoid all night and weekend on call with consequent adverse effect on family and quality of life. I thought I made reasonable efforts to keep my knowledge up to date. The 1990 contract was a bit of a watershed and in our practice we decided to go with all the opportunities presented including fundholding. We became a training practice and embraced the concept of life long learning.
Since then however I feel it has all been downhill, inspired by successive governments imposing top down reorganisation and non evidence based interference in general practice. Although I have retired my other half, also a GP has some years to go. She was much better trained than I, knows a lot more and works harder. Her days are just as long if not longer but so intense. No drug rep lunches or any non medical activity between morning and evening surgery. No time for the pastoral element that we old guys enjoyed and now exists only in fiction. Appraisal, revalidation and other bureaucratic waste of time activities are shifting from educational records to performance controls. Income has dropped in real terms and the public has been encouraged by politicians and media to expect and demand a level of service for which they are not prepared to pay. I also feel folk take less responsibility for their own health than they did even in the olden days.
A privilege and honour? Certainly. A vocation? Maybe. But that doesn’t pay the mortgage or school fees and merely serves to encourage our employers to abuse us.
Just before I left we had recruitment difficulties-and we were a very high earning practice. We also knew of lots of graduates heading for Oz. I don’t blame them. They had huge debts and did not wish to be shackled to the limitations and uncertainty of the NHS. If government was prepared to overlook the activity of bankers (bordering on the criminal) because of veiled threats to leave the country then a bit of effort to retain medical graduates isn’t out of order. I admire and support the juniors for taking a stand, something I would have been prepared to do and would encourage you all not to listen to the self deluded codgers of yesteryear or the self righteous martyrs of today. You are highly skilled highly trained highly motivated professionals and deserve appropriate respect and rewards.
Dr Martin Donnelly
A hoo-ha in General Practice
There’s a bit of a hoo-ha in General Practice at the moment. The government is portraying GPs as overpaid, lazy, lacking in vocation and generally a thing we could all do without. They would like us replaced by nurses, paramedics and pharmacists. Unsurprisingly, GPs aren’t happy. GPs are available pretty much 24/7, just not *your* GP. Extending GP hours won’t make your GP more available, just any GP. So continuity of care will suffer. Is that important? Are GPs a luxury?
Continuity of care is important. The reason I can see 6 patients/hr is because after 17 years in the same practice I know my patients. I know their parents. I know their kids. I know their medical history without spending precious minutes reading through their records, I know their preferences as to how they like to be addressed. I know those who like to be in and out in 5 minutes. I know who’s got a university education and I know those who use ‘fuck’ as every second word. And I can communicate with them all.
I know my patients. And they know me. I’ll give them 20 minutes if they need it, and they cut me slack when I’m running late because of that. I don’t clock off at 7, despite what Jeremy Hunt thinks. I run a business with a £1.25M turnover. I have transferable skills- I problem solve, I negotiate, I sell, I buy, I teach, I entertain kids, I console, counsel, persuade and encourage. I manage my staff, I have experience in IT, HR and in managing change.
I deal with joy, despair, trauma, loss and uncertainty; and can switch from one role to another in seconds and several times an hour. I deal with the best and the worst of humanity, the abused and their abusers , the scared, the anxious as well as the anxious well, the stoically seriously ill, the manic, the depressed and the psychotic, from cradle to the death bed.
In a half hour, I might congratulate a pregnancy, hear a first admission of being abused as a child and tell someone they have terminal cancer, and have to be equally knowledgeable and empathetic to them all. I can cheer, reassure, save lives and keep a poker face no matter what I’m told. I have practical skills, cognitive skills and communication skills.
The NHS pushes me out at its peril. I am a GP.
Dr Nick Bunting