Tuesday, October 16, 2007

Family Doctors Fed Up!

I can't say I was really surprised when I saw the BBC news headline today (click here for story) that one in six General Practitioners (GPs) is considering quitting.

That is tragic.

For the last 15 years of my health service management career I worked very closely alongside GPs who are also known as Family Doctors. I estimate I worked with more than 400 GPs in the course of my work and I would say I know 100 GPs very well. At least 20 GPs I would regard as good friends.

GPs are very harsh critics of themselves and they have very high professional standards.

Lets face it doctors are the brightest of the bright at school and they are ‘up there’ to be shot at from the moment they qualify as medical practitioners. The rest of us mere mortals often have to place our trust in doctors and as a result GPs are always ‘performers’ on the stage of life.

I am not just a 'blind' supporter of GPs and of course there are poor doctors – just as there are poor Lawyers, Politicians, Plumbers, Cleaners, Hairdressers and even ..Dare I say … health service managers!

My point is that doctors are no different than all of us and they have the same feelings as anyone else. I do however believe GPs have more responsibility than most of us.

When doctors make mistakes the consequences can be devastating – even life threatening. This awesome responsibility is carried by GPs every minute of the day.

I am not prepared to say that doctors deserve special treatment in any aspect of life but I do say, with confidence and some experience, that most GPs are dedicated, competent, decent, caring, compassionate people who see their main responsibility as looking after their patients.

I would be fascinated to hear views on this.


Unknown said...

That's a very good point, Trevor, that GP's have the same needs and feelings, but at the same time their responsibility is higher than the average citizen can face in her job.

I imagine someone (government...)will have to take some policies to cut down this trend.

Yesterday I read an article in the spanish press saying that in Britain there is a lack of dentists. I wonder if both problems are related, if they are a symptom of something happening in the NHS.

Trevor Gay said...

Hi Felix

You are very perceptive. There is a connection. It seems Dentists and Family Doctors are both disillusioned with the way the NHS is being run. This is not a new thing and for many years both professions have suffered low morale if you believe the trade unions. I think there is some exaggeration and not all doctors and dentists are disillusioned but there is no doubt there are some fundamental problems that only the government can sort out. The Labour government under Tony Blair gave more money to the NHS than any government in history but still there are problems.

Thanks again for your comments and I hope you are well Amigo :-)

Anonymous said...

I think a big issue to be addressed here is that a good doctor isn't necessarily a good practice manager. Like it or not, there's a mountain of paperwork around being a GP: from the nuts n' bolts of leasing and operating a building; all the employment issues about hiring and paying people; all the paperwork surrounding healthcare itself; and a whole lot more.

Mrs. F. works in a surgery and I can tell you from my experience that while the doctors are a terrific and conscientious bunch of doctors, they're in the main lousy managers. Even worse: they don't recognise this nor the need to recruit a decent manager - who they probably wouldn't recognise anyway!

All the talk about how much money is invested in healthcare and how much into admin is - in my view - falling wide of the mark. We need to ask what we do to get a top quality admin organisation into the NHS that supports the objective of getting patient care to the top of the priority list and that allows doctors time to be doctors and not administrators. The irony is, of course, we need the doctors to help us do this!

Trevor Gay said...

Thanks for that Mark.

You are right – many GPs are ‘turned into’ managers by the demands of senior NHS management which is ridiculous and a total waste of the money it takes to train these folks as doctors – they shouod be spending more time with patients – it’s not rocket science.

All GPs need good practice managers. In my experience where there is a good relationship between doctor and manager the surgery runs more smoothly than those surgeries where the GP tries to do the management stuff as well as being the doctor! Why are we not surprised by that? :-)

The back up of good admin is crucial. The biggest problem I have with spending more money on admin is that the NHS tends to then invent unnecessary and cumbersome processes and procedures which do nothing whatsoever to improve the patient experience. I would say they often make the patient experience less efficient and certainly less friendly. The money is not spent on front line admin support but senior management who are removed from the front line and seem intent on making things more difficult rather than easier for front line staff.

NHS managers are experts at inventing unnecessary work

Anonymous said...

You also need to look at how GP's get paid. Ever wonder why you're asked if you're a smoker or some other off the wall question when you've simply rung up to make an appointment? Answer: because the practice is paid 1p to ask the question. They're then paid against the number of smokers they ask to attend a clinic (note "asked" as opposed to actually attend). And the rules recently required them to ask everyone over the age of 14, i.e. asking children if they were illegally smoking! Which understandably enraged some parents but which the practice did because they clock up another 1p. Marvellous, eh?!

Trevor Gay said...

I rest my case Mark about managers making life complicated for people on the front line.

It’s the receptionist who gets it in the neck from patients and not the Chief Executive of the local Primary Care Trust! :-)

Anonymous said...

I'm not an expert on the British health care system, but my first instinct would be to analyze the centralize controlling authority that makes it difficult for doctors to operate freely.

In the U.S., doctors must also worry about lawsuits, frivolous and otherwise, since there seems to be no shortage of people wanting to jump on the gravy train and cash in through litigation.

Trevor Gay said...

Hi Cam

Thanks for your comments. Always feel free to comment from your perspective on the left hand side of the pond – you are very welcome – it is great learning for us!

The British National Health Service was created in 1948 and at its heart is the principle of free healthcare for every British citizen based on clinical need and not ability to pay. The government through the Department of Health monitors that important principle.

We have a very small (something like 10%) private health care system. Doctors and Dentists first priority must always be to provide free care. The service has inconsistencies but it is a universal healthcare system that aims first to protect the most vulnerable in our society.

We too have patients that complain of course but these are the great minority. I spent two years working as a complaints manager in healthcare and in my experience patients who complain have thought really hard before they complain. It takes some courage to actually make the complaint. There are those who make unjustified complaints but I genuinely say to you those can be counted on less than the number of fingers of one hand in my two years dealing with healthcare complaints.

I also take the view that complaints are good for the service because there is always something to learn from a compliant. And if the organisation is learning then at least it mean it is alive!

Anonymous said...

If you have a government it feels the need to govern. Indeed we expect them so to do. You’ve actually said it yourself Trevor. If in doubt say that the government needs to sort it out. If you have managers they want to manage something to justify their role. Employees look to managers to tell them what to do, what not to do. That makes life easy for them, it saves thinking, taking responsibility for themselves. It is a convenient arrangement. But it isn’t necessarily the most effective.

Time and time again we see legislation enacted that has perfectly reasonable aims but unfortunately has unforeseen consequences. A very simple example from long ago was the introduction of the 70mph speed limit to curb excessive sped on the new motorway network. As a result, the average traffic speed rose by several miles per hour as we now all felt the need to drive at seventy!

It would be interesting to see what continued to work and what didn’t if we abolished government, councils, managers, rules, policies, procedures, in fact all paperwork! My guess is that most things would carry on for a while, then we’d have chaos and anarchy, then some form of order and working relationships would develop and most things would work better than previously. The trouble is that people would then start inventing rules and ….!

I used to try to get the message across that processes are there to help with certain tasks. They are not the task in themselves. Unfortunately there are too many people in all organisations who fail to recognise this simple fact.

Consultant anarchist!

Trevor Gay said...

Thanks for that David – I often quote the story of the new build university. All buildings were completed and newly laid grass was sown building to building and no walkways, pavements were laid. After six months the tracks left by students taking the most sensible route created the template for the pavements and so the pavements were then laid. I love that story.

Had that university followed the traditional route and asked the ‘experts’ – architects/designers etc., there would have been plans showing pavements and they would have been laid. I doubt very much if they would have been in the same place.

Where there are no rules things can often work well - just as long as people do not interfere and start to regulate common sense.

Marilyn Jess said...

Hi Trevor,

"most GPs are dedicated, competent, decent, caring, compassionate people who see their main responsibility as looking after their patients."

Yes, so true. It's the health care system that's strangling their practices, and I say this as one across the pond in the USA. We all see it is broken, but a very small number of shareholders and insurers perpetuate an outdated and inefficient system that really serves no one well.
That is why the consumers that can, opt out of the system, for alternative care and better self care.
Where does that leave the GP? Over here, it's increasingly working as hospitalists, where they don't see patients in offices any more, but do have a more predictable schedule/life. And in more and more cases, the potential GP turns into a specialist or doesn't pursue medicine at all.

Trevor Gay said...

Thanks Marilyn - I think the biggest worry this side of the pond is will there be enough GPs to maintain the current level of primary care if GPs opt out because of too many interfering and unnecessary management processes.