Why British General Practice has died a terrible death
by Dr Vernon Coleman MB ChB DSc FRSA
When I was a GP, my partners and I provided a 24 hour service for our patients for 365 days a year (yes, including Christmas Day). We were legally and morally responsible for the health of all our patients all the time and although it was sometimes tiring, occasionally frustrating and from time to time annoying, it was a responsibility which we all took very seriously. We took pride in what we did, and were conscious of the fact that GPs were the backbone of the health service.
Today, things are very different.
GPs in Britain work office hours and patients who need medical help outside those hours must treat themselves, rely on an absurd telephone service whereby untrained personnel offer the sort of misleading and potentially dangerous advice which used to be offered by the untrained woman behind the counter in the corner newsagents or make a trip to the casualty department of the nearest hospital which has one. If they decide to visit the hospital, they will wait between four and nine hours to be seen.
Two things destroyed general practice and, therefore, put the finishing touch to the United Kingdom’s health service.
First, in 2004 the Labour Government, obeying instructions from the European Union, introduced a new contract which allowed GPs to stop seeing patients out of hours. The contract, which offered doctors far more money for doing far less work and taking on far less responsibility, was absurdly over generous and GPs signed it with enthusiasm.
Before doctors signed the contract, patients could ring their doctor at any time of the day or night and expect to be seen by him or her, or by another doctor acting on their behalf. If a doctor was ill or on holiday, he would have to provide a locum and the locum would, quite possibly, be his retired predecessor.
After doctors signed the contract, patients had to fall ill in between the hours of nine to five. Their chances of seeing a GP at night or over the weekend fell to the sort of odds usually associated with winning the lottery.
The second thing which destroyed general practice was the introduction by the General Medical Council of new rules which ensured that once a doctor retired he had to hang up his stethoscope for good.
It was the General Medical Council (GMC) which forced the NHS to rely on importing foreign trained doctors who speak no English but who have qualifications recognised by the EU. It did this by forcing all doctors to jump through the pointless and absurdly bureaucratic hoops of something they call ‘revalidation’ if they wish to retain their licence to practise – a process introduced as a result of the efforts of a GP called Dr Harold Shipman. (Shipman was a rogue doctor who killed over 200 of his patients.)
Retired GPs can no longer help out during sickness or holidays, and so foreign doctors have to be imported. There are shortages of GPs all over the country and in just about every area the explanation is the same: GPs are retiring early (often in their 50s) because they are fed up with the GMC’s absurdly bureaucratic revalidation process. Every one of those retiring GPs is permanently lost to the nation. Once a doctor decides to retire, he will lose his licence and be unable to do locum work – even in emergencies. The result is that the NHS has to pay foreign doctors a fortune to fly over and do locum work. The fact that they do not speak English and have not had to cope with the GMC’s revalidation procedure doesn’t seem to bother anyone. It seems to me clear that the GMC would rather have Britons looked after by poorly trained foreign doctors who don’t speak English than by experienced British doctors.
The internet will kill General Practice but the GMC has wounded it fatally. It is no exaggeration to say that general practice in Britain has been dealt a death blow by a bloody traffic warden. If there are no mature doctors working in your practice and you have difficulty in getting a doctor to visit you at home you can thank the General Medical Council and the traffic ticket chief who have finished off medical care in Britain, completing the job started by the EU friendly Blair and Brown when they allowed doctors to opt out of 24 hour cover and start working office hours.
I have always been irritated to the point of irrepressible contempt by bureaucratic arrogance and in my experience the staff working for the GMC have that in spades. (I have had little respect for them since I first started to practise medicine.
I was threatened with a public defrocking when I wrote my first book because I was accused of ‘advertising’. This was then seen as a far more serious crime than being drunk in charge of a scalpel or sleeping with the patients.
Even though I had no private practice, and my authorship would have had no possible impact on my professional earnings, I found myself constantly defending my good name. The drug companies who were criticised in my first book (The Medicine Men) were the only complainants but the General Medical Council listened to them with great respect.
Eventually I grew so tired of defending myself that I voluntarily removed my name from the GMC register and put myself on the retired list. Naturally, this gave those who didn’t like my books the chance to claim that I had been struck off.
The GMC introduced its mad revalidation idea in the belief that the evil Dr Shipman wouldn’t have been able to jump through any of its bureaucratic hoops. That was, of course, absolute nonsense, and only very, very stupid people could have thought it could possibly work, for Dr Shipman could jump through hoops better than any other doctor in Britain. That’s why he got away with being Britain’s most successful serial killer.
The direct result of the GMC’s half-witted programme is that a huge number of experienced clinicians in their 50s and 60s are taking early retirement. Once they are unlicensed they cannot work part time or as locums and so the NHS has to import foreign doctors who may or may not speak English but who certainly haven’t had to go through the General Medical Council’s hoop jumping exercise.
I find it difficult to avoid the conclusion that the revalidation programme is an exercise which is designed solely to make the inept and immeasurably barking GMC staff seem important and indispensable.
The police who are hired to protect us all often treat all suspects like criminals in order to break them down. This attitude is widespread among public servants and, sadly, even includes doctors and nurses now and hospital patients are, too often, treated as if they are a worthless nuisance. Insurance companies use the same unpleasant trickery when confronted by claimants.
And the GMC seems to me to have adopted this way of working.
I really do think that the bureaucratic GMC should be renamed the Department of Pointless Meddling and Harmful Interference since it clearly exists to mess up things which are working perfectly well.
There is a longer explanation of how the GMC works in my book Bugger Off and Leave me Alone. It is perhaps sufficient to say that the medical profession is now completely controlled by a former parking ticket bureaucrat and, in my professional view, is probably responsible for more deaths than Dr Shipman and cancer combined.
The odd thing is that the GMC introduced regular appraisals just as large companies around the world abandoned them because they are expensive (in terms of time and money) and totally without value.
Copyright Vernon Coleman 2016