Why can’t I see my GP? — book review by John Illman

Why Can’t I See My GP? The Past, Present and Future of General Practice,  by Dr Ellen Welch,  Calon, £16.99. Reviewed by John Illman

Not so long ago GP telephone consultations were considered unethical, depriving the doctor among other things of critical non-verbal cues that emerge the moment the patient enters the consulting room. They were also said to be the resort (I’m not sure why) of work-shy, lazy GPs. But now it may be unethical, sometimes, not to offer patients telephone consultations. These are desperate times.

GPs have more than a million appointments daily, with 1,850 fewer doctors than in 2015. This number is set to rise by about 8,800 by 2030 unless things change. The 2022 GMC workforce report showed that 4,843 doctors left the UK to work overseas between May 2021 and May 2022.

Media criticism

In 2019 Welch became one of a new generation of ‘remote GPs’ and says she hasn’t seen a patient face-to face since 2019. Dismissing widespread media criticism about telephone consultations, she insists that an experienced remote GP is better than no GP at all in a world where GPs have become ‘a punchbag for a failing system’. She refers patients who need physical examinations to colleagues. 

Remote medicine, she argues persuasively, increases efficiency and provides a safety valve to take the pressures off a system which is at breaking point.

Why? There is a plethora of well-published contributory factors. For example, the workforce has declined since 2015 despite promises from secretaries of state to recruit thousands of additional GPs; an ageing population; decisions to freeze NHS staff pay; additional responsibility for GPs with patients unable to access secondary care; increased paperwork at the end of each surgery; increased numbers of patients per practice because of closure of nearby surgeries; time constraints for seeing patients… 

Emigrating

Small wonder that more GPs are going private; or emigrating to countries such as Australia to ‘double their salaries’; or becoming locums who can work when they like.

Welch is not a lone voice. Her book has more than 20 contributors, mostly fellow GPs. In the foreword, Dr Amir Khan, a  Bradford GP partner, university lecturer and media medic who appears on Lorraine and Good Morning Britain warns: “Primary care holds the NHS together: without us, the entire system collapses.

“Then what are left with? A private healthcare system. Be under no illusion, we are fighting for our patients: their right to see a GP when they need to and to continue to receive free healthcare free at the point of need. We are worth investing in.”

It is worth noting in this review for the MJA a disturbing recurring theme in this book — negative press coverage. For example, to quote a few of many examples, Khan complains: “There is not a day that goes by without a story in the papers or online about people struggling to see their GPs. It is not because we as GPs are lazy fat cats hiding at home…Despite the barrage of abuse we take from the media…we try to do our best by our patients.”  

Reality of the job

Welch says: “Headlines have frequently contradicted what we know to be the day to day reality of the job.” 

Ron Templeton, a retired academic tutor at Liverpool Medical School, says: “If I were starting out on a medical career, I would certainly be put off choosing general practice because of the continued hammering and bad publicity in the press, especially newspapers, of how bad GPs are.” 

Chapters include ‘Does it work better elsewhere? (It suggests that life really is better elsewhere); What does a GP do in today’s Britain and — critically — The future of general practice. 

Welch proposes moving the NHS from the political agenda. She says: “Form a cross-party group to focus on the NHS and healthcare, comprised of GPs from all parties, alongside experienced healthcare professionals, so that each time an election rolls around, the service is not at the mercy of politicians promising polished soundbites.

Step back

“Each new government generally brings about a costly, un-evidenced re-organisation of the service. Step back from this and focus on the problem rather than winning votes.”

It is difficult to disagree with this analysis. It is equally difficult to imagine the two main parties agreeing to it. 

Welch also proposes putting the NHS on the school curriculum, an idea with which it is hard to disagree. See The Doctors’ Association UK website (www.dauk.org for more details about this and other ideas to reform the NHS 

Welch dedicated the book to Dr Gail Miligan, a dedicated Surrey GP who found the ‘the pressures of her job…too much to bear.”

Her death attracted extensive publicity, but was not an isolated case. The NHS Practitioner Health (NHP) a mental care service for health and care professionals, recorded 18 deaths in the 12 months to October 2022. This number is believed to be an under-estimate. 

Suicidal thoughts

In a survey of almost 6,000 health professionals registering with the NHP during this time, 1,836 reported having suicidal thoughts on several days. Just under a third (496 people) had made plans to end their lives in the previous week. 

Reading Welch’s book made me angry — the government should treat GPs with the same kind care and compassion that we as patients like to receive from them when we are at our most vulnerable. GPs have never been more vulnerable than they are now.

 We need to exorcise traditional ideas about what makes good general practice. The old image of the GP as a kindly man with the time to pop in for a home visit anytime day or night is an outdated fantasy in the new online world where so many GPs really are overwhelmed — despite ideas to the contrary writ large in the Telegraph,  Daily Mail et al. 

Declaration of interest: Ellen Welch is a former student of John Illman.   

Click here to buy the book on Hive (£13.95)  — a British tax-paying company which supports independent High Street booksellers.