During the negotiations that established the NHS in 1948, Lord Moran, one of the most influential doctors of the day, declared that GPs were merely the doctors who ‘fell off the ladder’, lacking the ‘outstanding merit’ to become hospital specialists. It could be argued that the history of general practice and the development of primary care since that time has been a battle to show the old guy just how wrong he was.
Aneurin Bevan and the other labour politicians who created the structure of the NHS focussed on getting the dominant hospital consultants into line. Famously ‘stuffing their mouths with gold’, they failed to include general practitioners as paid employees of the NHS. Ever since then, GPs as ‘independent contractors’ have been largely at the mercy of political and economic forces outside their control…
And that’s how it feels to be a general practitioner. Buffeted and carried along by currents that are hard to influence, changes are imposed on the profession more or less at the whim of a political class with scant knowledge of medical or community-based reality. Most recently Andrew Lansley’s Health and Social Care Bill is, without their consent, proposing to give GPs responsibility for managing the entire NHS budget at a time of enormous financial constraints and rising demands—thank you very much.
Of course the pressures on general practitioners are not only as a result of disastrous management and ideologically driven political interference—people come for help with their medical and social problems. And this is when the fun begins. Open your doors and see what happens. Soon your surgery will be full of all sorts of people seeking help.
Over time each general practitioner gravitates to a community in which they feel comfortable and attracts a clientele that suits their personality and professional style. For the thirty years of my ‘career’ as a GP I worked in inner city areas and loved to work with people who had (and probably still have) long-standing conditions. In my last practice I saw one young man every Monday for twelve years. We may have been addicted to each other. Other general practitioners seem to collect around them people with other needs or perhaps with more technical medical problems.
The main change during the time in which I was a general practitioner is the growth of the ‘primary care team’. Entering my first practice in 1980 I found myself working with one other GP and a woman who cleaned and made occasional cups of tea. When I retired from practice in 2010 the team included amongst others a physiotherapist, a herbalist, a massage worker, a pharmacist, several psychotherapists and counsellors and a wonderful team of specialised nurses all backed up by a highly skilled management and administration team.
Although there is often an emphasis placed on the technical advances that have been made in medicine, in my experience this has been less impressive than wonderful growth in ways that the entire team can work together to help people going through periods of distress in their lives. Together a well-functioning team can fend off interfering management and service the needs and wants of the people in their community.