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General practice today: ‘endless questions, few answers’

28 August 2018

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Caron Tremaine-Tucker, practice manager at St Chads & Chilcompton Surgery and Somerton House Surgery, on the GP recruitment crisis and the future of the NHS 
Problems with GP recruitment have finally hit our surgeries, St Chads & Chilcompton Surgery and Somerton House Surgery. We didn’t think it would happen in this area, at least not for a while yet, as we’ve always attracted doctors without too much trouble and are in a pretty, semi-rural setting close to Bath. This year our relatively smooth recruitment path has, however, changed, and this is our story.
Following the retirement of one of the partners in April we had an opening for a salaried GP to work six sessions a week and advertised locally within our organisations, which is normally enough to attract a doctor.
We received a few enquiries and one very interested applicant who we interviewed and offered the job. However, we immediately experienced problems as the contract we would normally offer was no longer acceptable – the new doctor wanted different terms, as offered by the BMA. That’s good, I hear you say, the BMA is a professional body that helps salaried doctors and practices alike.
However, the new contract gives very strong rights to the employee but, it seems, very few to the employer. Nevertheless, we like to do the right thing and gave a BMA version of the contract to the candidate and thought this would solve the problem.
How wrong we were. The doctor was not happy with the amount of work involved, the number of phone calls, appointments, visits, tasks, referrals, and so on. They found it hard to fit it all into their four hours and 10 minutes’ worth of sessions, and they wanted to be able to go home on time when their sessions were supposed to have ended. And why shouldn’t they, it’s what we all want, isn’t it? 
In the end, the candidate decided to resign shortly after being employed, and work as a locum instead. Locums can dictate their terms, charge higher rates, pick the hours they want to work, decide whether or not they want to include visits or charge extra for each visit. They can even negotiate how many patients they see during the hours they work. In our area, we try to agree a pricing structure but when you’re desperate, this like everything else, goes out the window.
So we started again and this time we decided to try and attract more interest by spreading the net wider, so we advertised in one of the national publications. I gasped when I was informed of the price – over £2,000, for one week in the print publication and two weeks online. I tried to imagine the money they must be making out of the crisis in recruitment within the NHS, while the NHS as an organisation struggles daily.
From this expensive advert we received one application and we spent valuable time showing the applicant around, being as hospitable as possible, even though we knew the person had been to several other practices that day.
I put in overtime to help, partners took time out to introduce themselves and to explain our systems. Even after all that, however, we ended up never hearing from the person again – and we were still £2000 pounds down.
On a positive note, we are in an enviable position as a training practice. We also have new, freshly minted doctors and we were lucky on this occasion that two of them wanted to stay with us. However, they are young and the world is a big place. How long will they want to remain within a struggling NHS, where we are advised that everything needs reorganising, told that bigger is better and more efficient and that it will save the NHS money? 
The bigger an organisation is the easier it is, in fact, to lose control, lose touch with employees, and lose the family doctor element, continuity of care and patient choice. In which case you have to ask yourself where it’s all going? I wonder how many more abbreviations, organisations and reorganisations there will be in the future; how many more HAs, PCTs, CCGs, STPs, LATs, LMCs, and so on.
We are currently swamped by ineptitude  – adding to our already overburdened roles – including clinical and administrative contracts being given to organisations who have never dealt with patient care and struggle to deliver the service. Will this contribute to the NHS finally tipping over?
I try to remain positive, I tell myself that they are trying to reorganise for the good of the NHS and the staff within it. However, how many of us have not seen this cycle time and time again? With good systems destroyed and replaced with inefficiency.
So, is there light at the end of the tunnel, and how much money has been spent on re-organisation that could have been dedicated to recruiting and training doctors? At the moment, there are endless questions, but few answers.
Caron Tremaine-Tucker, practice manager at St Chads & Chilcompton Surgery and Somerton House Surgery