Written evidence submitted by Dr ben Keeper (FGP0037)

 

I have worked in the same two partner rural General Practice for 28 years – 26 of those as senior partner. We were once voted the top NHS service within Lincolnshire in a Healthwatch poll and consistently appear in the top 5-10% of local practices for patient satisfaction in the NHS surveys.

 

I am now 56 years old, recognised my own burnout about 6 years ago and, with support of my partner, reduced from 7 session to 5 sessions.

Over the last 3 years I have had 2 separate sessions of Mentoring and been on a BMA led Time Management course.

However, even working just 5 daytime sessions as a partner I was logged into my laptop doing patient related work for an average of 51 hours a week. Six evenings a week, (even when not working in the day, even on days I was paying our salaried doctor to see my patients for me), I had to login to clear results, tasks, notifications and scanned letters. This is not part-time work by any normal person’s estimation – and each and every task requires full concentration.

On top of this there is Personal Development to satisfy the Appraisal Process and the management of the business.

I have taken 24 hour retirement already and retire as partner in March 2022 – living proof that overwork leads to early retirement and loss of highly experienced doctor manpower to the NHS. The daytime work of consulting with patients is not the problem – it’s the out of hours administration that is the death knell for GPs like myself. QOF, QI, PCN targets (absolute craven madness) and CQC inspections are the killers.

The recent addition of PCN targets on top of QOF is just so irrational in the current workforce crisis that I struggle to be polite in the expression of my opinions here – imbecility barely scratches the surface. Our LMC more politely say “Simplify GP contracts so that the funding flows through fewer contract streams”.

 

26 years ago 2 partners and 2 receptionists managed all patient contacts, now we are 2 partners with a directly employed staff of 30 and numerous attached Clinical staff supported by the PCN and CCG.

26 years ago we looked after 3600 patients who visited the surgery, on average, 4 times a year.

Despite reducing the Practice Area to it’s core boundaries we now care for a practice list of 4800, with an average footfall through the surgery door of 9 times a year.

 

My calculations for the number of consultations in Primary Care a month (excluding Covid jabs) divided by the number of WTE GPs currently working give 100 consultations per day per WTE GP. I cannot personally see all 100 patients face to face myself.

Politicians MUST be honest with the public, stop demanding face to face appointments with ‘your GP’ and start educating the public about the extended Primary Care Team.

Compared to 1993 we no longer refer everyone with BP, Asthma, COPD, Diabetes, Chronic Kidney Disease, Hyperlipidaemia etc – we, as a team. diagnose and manage these conditions in house.

 

Recognising that the country cannot, and should not try, to fill all the gaps by training more GPs this government has chosen to introduce Clinical Pharmacists, First Contact Physiotherapists, Primary Care Mental Health Practitiones, Care Co-ordinators, Primary Care Paramedics,  Social Prescribers, even Befrienders and many more ancillary roles to help GPs out. (AARS)

This is called Skill Mix. These professionals variously assess, investigate, prescribe, refer and treat within their own specialties better than I, as a GP, can do.

Politicians need to understand the provision of modern primary care and be much more careful with their public statements. Indeed there is need for a proper Public Information Campaign on this issue.

 

To encourage self-care and reduce demand on General Practice, properly blacklist cheap, widely available medication that you would like patients to self-source. Paracetamol, Ibuprofen, Chloramphenicol, Cetirizine etc are examples. Make it plain that GPs, especially dispensing GPs (where there is no nearby pharmacy), can issue a private prescription for these items to their own patients on demand. This could include all items available OTC and could also include some Pharmacy Only Medication. Guidelines are too wooly, with fair implementation impossible – properly add them to the blacklist.

 

More GPs are opting to become salaried rather than being tied to a partnership. One advantage of the partnership model that should not be underestimated is that as a Partner you do not throw a sickie’ because it hurts your own business – the NHS will get more lifetime man-hours out of a partner than it will out of salaried doctors and locums.

 

Dec 2021