3. The doctor’s changing role

A wry comment from Dr Alexander Barber, “It is often said that we don’t train enough doctors. We do. They’re quite sensibly working outside the NHS, or doing as little NHS work as they can get away with – retiring, semi-retiring, working abroad or moving into industries that pay a consultant’s salary or more”.

John Adcock reflects: “It is time that GP practices and hospitals were paid per consultation or procedure, as they are in the private sector, instead of being paid regardless. The best would then expand, the worst would be taken over”.

Dr A C E Stacey MRCGP (Member of the Royal College of General Practitioners) says that Britain’s hospitals are overwhelmed because “full-time” GPs work an average of 3.5 days a week, and even then employ telephone and video links before agreeing to see a patient in person.  Rather than manage acute situations, they now advise sufferers to dial for an ambulance. This results in dissatisfied patients, resentful hospital staff and a quiet life for well-remunerated GPs. Most are far from overstretched, and the Royal College of GPs should not claim that they are.

His recommendation: GPs should fulfil their contractual commitments

Dr Malcolm Freeth recalls that when, in 1967, he started his first house job as a junior doctor at the Royal Victoria Hospital in Bournemouth (above), it was run by a medical superintendent, a (proper) matron and a small number of clerical staff working from three rooms. In his two years there, he witnessed few problems, good morale and great teamwork – even when he was on call on alternate days during his six-month obstetric job.

His recommendation: hospitals once again could be run by a medical superintendent, a (proper) matron and a small number of clerical staff

Dr Nigel Garbutt, who used to be a country GP, looks at the reasons patients are now attending A&E (given here).  He estimates that about 70% of these cases would once have been dealt with at the surgery or at home, both in and out of “office hours”. He used to deal with minor accidents, assess acute chest and abdominal pain, and deliver babies. GPs were later enabled to leave the burden of out-of-hours work behind (Labour GP contract of 2004) and are now very unlikely to return. A&E services are having to adapt at every level.

His recommendation: 70% of A&E cases could once again be dealt with at the surgery or at home, both in and out of “office hours”

Dr Andrew Inglis is a retired GP. In the 27 years that he was a partner in a practice, there was a wholesale transfer of the management of long-term conditions (such as diabetes, asthma and heart disease) from secondary to primary care. This was clinically appropriate.

His recommendation: long-term conditions (such as diabetes, asthma and heart disease) could once more be managed from secondary to primary care general practice, community pharmacy, dental, and optometry (eye health) services)

Dr Ian Reekie: “When I was a committee member of the Association of GP Hospitals in the 1980s and 1990s, a network of General Practitioners (GPs or family doctors) replaced the panel system. They were responsible for personal primary health care and received fees which were set and paid nationally. They were also the gatekeepers to other health services, referring patients on to hospital services as they thought appropriate”. (The history and development of the UK NHS 1948 – 1999)

He recalls: “We protected the interests of 400 such hospitals in England and Wales. These establishments looked after patients not requiring specialist treatment in district general hospitals. They were local, efficient and cost-effective, and many had 24-hour casualty departments. They provided a solution to “bed blocking” and kept vast numbers away from A&E. Sadly, successive administrations failed to recognise their value, and it became a struggle to keep them open. The Labour GP contract of 2004 put the nail in the coffin, with GPs leaving work at 6pm and becoming inaccessible at weekends. The end result is what we see today”. 

His recommendation: a network of General Practitioners (GPs or family doctors) responsible for personal primary health care – gatekeepers to other health services.

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