The good news is that I am committed to writing this blog for another year. The bad news is that the material will then dry up.
I had my annual appraisal this morning with an old friend. Martin was in the year above me at school, but I only really got to know him during our time together on the local Vocational Training Scheme (for young doctors training to become GPs). I was happy to remain a simple trainer but Martin rose to the giddy heights of Course Organiser. He has always impressed me by his kind-heartedness and dedication. He is from a medical family and is now the senior partner in the practice where his father was senior partner before him. Although the patients are mostly from deprived council estates, many hospital consultants choose to register with the practice which speaks volumes about the quality of care and the dedication of the GPs.
I thought he looked a little tired and careworn. We discussed the future of general practice, which looks as though it is going to change markedly. Our workload has increased considerably over the past few years. We now do a lot of the management of chronic disease that used to take place in hospital out-patient clinics, and are doing a huge amount of public health work, screening treating and monitoring heart lung and kidney disease. All this is in addition to our traditional work of dealing with the new symptoms that bother patients, explaining and interpreting what is going on, doing terminal care, and generally being kind. Our days are long, busy and stressful, so working extra hours in the evenings or weekends really is a big deal for us. Our practices are mostly too small to allow the doctors to work shifts to cover long periods of time.
There are a large number of young GPs coming through the system and most of them have never been a partner, taking the risks and the profits of our small businesses. Instead they have been employed by practices as salaried GPs. I think that the practices that exist at present will gradually be replaced by large “polyclinics” run by large private sector companies, employing numerous doctors nurses and other staff. This will not necessarily be a good thing for patients. You might be able to get an appointment at a relatively convenient time, but this would undoubtedly be with a nurse in the first instance. If your condition were deemed severe enough to warrant seeing a doctor it would not be with “your” doctor who knows you and whom you trust. It would be with someone you might not have seen before and might well not see again, who could well be efficient but might not have a lot of commitment to you as a person. The “doctor-patient relationship” would be just a duty owed during a ten minute encounter rather than something of value built up over time. It is hard to see how doctors would take an interest in and responsibility for the ongoing welfare of individual patients, and there could be less kindness shown. Visits that were not strictly necessary would not be done, hands might not be held as often or for so long. Or so I fear.
Martin was very supportive and encouraging (as I had expected) and, bless him, he had read the entire 100-page print-out of this blog. One of the items in my “Personal Development Plan” is to continue to write it. We didn't put much else in the Plan because I have decided to retire as an NHS GP in March 2009. As I hinted back in August I am going to move to France and “live on my wits”. I should be able to live on the pension I have built up, and may or may not supplement this by doing a part-time job once over there. I shall be sorry to leave Martha and my other colleagues, and I shall miss many of the patients. But I will not miss the stress. Myrtle perceptively said that my love affair with the job has gone. To me it seems that I have worked dutifully at school, at university, during house jobs and GP training, and then for over two decades as a GP. Back in my training days, a hospital consultant whom I very much admired said “the danger of this job is not that you might kill a patient, it is boredom at thirty”. He was some twenty years out, but his judgement was otherwise sound. I think I ought to do something else now, or rather in fourteen months' time.