Opinion, work life balance

30 Oct 2015

Is six clinical sessions the new full time GP?


Right now, the newly qualified GPs are launching themselves into their careers. Many  will kick off doing 9 or even 10 clinical sessions, believing that that’s what a GP does full time.

Give it a couple of months and then you’ll catch them in the kitchen on Friday morning looking exhausted and pale at the prospect of another full day. “I can’t keep seeing this many patients,” they’ll say.

And then someone will come along and tell them: “look, you just can’t see patients full time.”

Here’s what many GPs are whispering: two sessions a week isn't enough to keep up with medicine; four feels good and some say the maximum is six.

Why? Two reasons. Because the wheel of primary care has become too big and over-regulated to keep turning on its own axle without GPs disappearing off to do something else. Be a CQC inspector (if you must), an appraiser, sit on the BMA, the LMC or do commissioning work if you want. The portfolio life is appealing.

And secondly (and most importantly) because sitting seeing patients on your own all day is becoming just too damn hard.

Why is it so difficult? Isn’t it what we set out to do?

The truth is that seeing patients, day after day, in 10 minute slots where doctors are required to absorb all of life’s tapestry of emotions is just too much for a professional sitting in there on their own.

In a single session, the average GP experiences, feels (and tries to contain) people with anger, grief, anxiety, depression, fear – the whole gamut of human pain.

People say primary care is rich – it’s apparently “the best job in the world” – but spend 10 sessions a week at the coalface and it gets a bit too rich, like the milk just went sour..

Right now we're trying harder and harder to meet the demands for more. More treatments, more consultations, longer hours of this with appointments and more convenient times. Oh, and a bit of continuity as well please.

Many other jobs dealing with this type of material (the abused, the vulnerable and the dying) have some kind of clinical supervision built in. Counsellors, drug workers, social workers – there are even HR officers who get a session or two a month to go and ponder it all.

If GPs are to sustain this level of caring, then primary care needs an inbuilt system of clinical supervision. Somewhere where we can diffuse, make sense of it all and discharge a bit of crap that we otherwise end up carrying around.

Supervision isn't the only factor of course - demand management, tackling the complaints culture, adverse press and more reasonable hours would all help GPs commit to going back to seeing patients full time.

GPs are not the sponges of society to mop up spilt milk. Until the system of on-tap compassion with no refill mechanism changes, the mythical 5000 new GPs will be doing less clinical time and disappearing off to the portfolio life instead.

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