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I didn’t set out to be a GP. But it has been the best decision I’ve made. Having been a GP for 33 years, I’ve never been bored. I’ve been upset, angry, frustrated and exhausted, but not bored.
The variety and opportunities to vary work and roles is enormous. I’ve worked as a partner, locum, teacher, trainer, medical director, civil servant, commissioner, LMC rep and GPC rep. I have worked in the West and East of England, in London and in Africa. I’ve worked hard long hours, but have been fairly remunerated for that work. And I feel so lucky to be able to say this.
General medicine as a person-orientated science remains my abiding passion in its complexity and demanding rigour. Over many years the party political interference has been unhelpful. It is my view that by neglecting to focus on the medical science and encouraging the wider remit of the GP to include being expensive and ill-trained social workers and counsellors, the RCGP has also aided the demise of general practice.
In my career, I’ve not seen general practice under so much pressure, or so many GPs demoralised as now. GPs face enormous pressure to change, due to the combined effects of:
The era of small practices managing alone and the continuity of face-to-face clinical contact has gone. What will replace it is yet to become clear. The advent of ‘working at scale’, alternative multidisciplinary community providers, calls for longer opening hours, and the varied workforce skill mix are part of this change.
A key issue for me, via the GPC sessional GPs subcommittee, is to include our voice in the emerging primary care federations and in other new community primary care provider organisations. To date much of the conversation about these structures has been with only GP partners. Through our inclusion we need to secure fair terms and conditions of work while retaining clinical freedoms (both in and out of hours). The terms must include pay, pensions, CPD, leave, hours and remit of work. Retention and recruitment of GPs depends on this.
There is a comfort in knowing that as a whole, GPs are good at change. We are fortunate in having a new generation of GP leaders (including those on your subcommittee) with energy, passion and intellect. However, it is debatable whether the future role of the GP is one for which I’d personally sign up. I am at the tail end of my medical career and sadly, that feels like a good place to be.
Dr Elizabeth Robinson is the sessional GP representative for the East of England