26th January 2015

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Health-Chat with Roy Lilley 

Dr Sarah Woolaston MP Chair Health Select Committee

11th March - King's Fund 5.30.  Details here.

Serious thinking
News and Comment from Roy Lilley

If you keep doing the stuff you're doing, you'll get the stuff you've got. Forgive me paraphrasing Henry Ford but I'm short of time.


The NHS is short of GPs and also short of time to find more. The senior ones are hacked-off and grabbing retirement options. Youngsters look in the papers and see GPs hammered for not diagnosing cancers, not opening for long enough and bringing on Armageddon by prescribing too many antibiotics.


The rest of us see the news; there is no chance of getting a GP appointment this side of Easter and watch Inspector Field, on tea-time telly, demolishing morale with his tall-tales of dangerous practices.


GP leaders rightly point out they are providing 90% of first contact for 11, or is it 9, or maybe 8% of the budget. Do we want doctors or jugglers? Medics or magicians?


So let's think about this. I am young, the brightest of my generation, gone through the grind of medical training, suffered sleep deprivation, abuse, multi-exam-itis and can work just about anywhere I want. Why would I choose to be a GP?


If I did I would have no chance of earning a nice few quid, on the side, in private practice and I would end up being a budget manager for a CCG, until the next upheaval and they are called something else.  


I'd spend hours listening to my stethoscope, trying to sort out chesty coughs knowing it is housing, joblessness, lifestyle, diet and personal relationships that are at the heart of what I should prescribe for.


During the day, crossing my fingers and at night, crossing myself, hoping I haven't missed anything sinister and end up with a kicking from the GMC.


In an attempt to turn the tide the RCGP have produced a glossy video; 'come and be a GP'. It is very well produced, nicely shot and lit but manages to suck what little glamour and excitement there might be for a young doctor in family practice, right out of the frame. It is soooo pedestrian.


Worse, there is a howling production error. The male characters in the early shots are seen speaking. The male voice-over is saying something completely different; so for the first few minutes we are left wondering if there is a fault in the lip-sync. Why am I not hearing what I am seeing?  


By the time you've got your head around it the film is half finished. Oh, and there is a lot of stethascoping and forms. The locations are very middleclass, dahling! The cutting edge of medicine, by the fireside and the flat screen telly. The practice... an Ikea showroom.


This is a movie made by comfortable, middle-class doctors, about why other doctors will want to be like them. It's like a membership advert for a golf club.


Why be a GP? I'll tell you. Because it is difficult, gritty, challenging, repetitive, boring, exciting, worrying, satisfying, frustrating and at the edge.


It is where the biggest difference to life and lifestyles can be made. It is where the battle lines between bureaucracy and the business of care are drawn, daily. It is where doing more with less is the norm. Being a GP entrusts you with a key to open a door into people's intimate and secret lives.


The real message is; treating a cancer is a well-defined pathway, finding one is about being a detective, backing hunches and being brave. A colon specialist has to know all about the colon. There might be 78 other organs and 7,500 named parts of the human body. A GP is in touch with them all, on a daily basis, in ten minutes. That's pressure.


Who will watch this film, when will they will see it? Will it matter? Sustaining family practice will take more than a movie. Reshaping, redesigning the workforce around the work of the future is the priority.  As work is redefined, so is the workforce. 


We may not have GPs in ten years' time; healthcare will have changed that much. What we do, who does it and where... all up for grabs.


We can't survive by keep doing what we've always done. This is not a film about the workforce of the future.


The RCGP have some serious thinking to do.  


'What is the point of a select committee' come and join me in conversation with Dr Sarah Wollaston MP, chair of the Health Select Committee.

 Kings Fund 11th March - details here. 


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