I’ve just been to a careers seminar about law. Nope, not a change for me – I suspect I’d look a bit conspicuous in the line-up for pupillage. I was there because one of my offspring is considering law, they are sadly not keen on following Dad into medicine.
One speaker at the seminar stood out for me and, curiously, reminded me of a visit to my hairdresser over the weekend. Bear with me.
“The main reason I do this is because it’s fun”, said the barrister. “I couldn’t stand all that paperwork the solicitors get embroiled in. I get to stand up in court and argue things, and I love it.”
I reflected on decades ago when as a medical student I met my first patient. This was a situation where the health professional was more terrified than the patient, but (in a type II way) it was fun. I loved the interaction, gleaning details of their life, and trying to put together some sort of clinical story from the rambling tales. I still find it fun (more in a type I than type II way these days), but only when I truly have the time to enjoy it. When I’m rushed, I hate it.
It’s a feature of a health professionals’ life – we do pretty much the same job from the day we graduate until the day we retire even if, like me, we end up with part clinical part managerial careers. I explain that to anyone who asks me for medical career advice. You have to be bright to get into medicine these days, but there is no point getting in unless you truly enjoy the human interaction.
We need the time though, and we’ve been losing the battle for time over the last couple of years. Our activity data in Surrey shows GP activity above and beyond that pre-pandemic, we are dealing with a huge backlog of need and perceived need (I dislike the word “demand”), and for many practices it feels like firefighting every day. GP training embeds in you the ingredients of the perfect consultation – thoughtful, caring and reflective – but you simply cannot do that whilst you are firefighting. There is then no pleasure in the consultation.
We now have an opportunity. Claire Fuller’s review and recommendation around the direction of travel of primary care sets out both challenge and hope. We need to streamline our urgent care services, not least to stop Primary Care being loaded to the point of distraction by urgent care need. We need to use the space we create through that change to re-invent and re-invest in our complex care services, with true continuity. That means GPs working with the wider team to properly get on top of the longitudinal care needs of the most vulnerable patients we have, and for those patients to retain and develop the relationships they have with a small team, led by their trusted and known doctor.
This won’t just happen passively though. It needs individual practices and Primary Care Networks (PCNs) to think carefully how to develop these two key elements – Urgent Care and Complex Care – and it needs a hundred or more coffee-room conversations with everyone working in primary care to get consensus and buy-in for the change. Top-down directives won’t work here. Even better, we need to talk to our patients, our communities – the man in the corner shop, the lady in the post-office, and the barber. Patients need to understand why we are changing urgent care services, why they’re seeing a paramedic (not a doctor), and maybe why it involves a drive to somewhere other than popping into their local surgery.
Which brings me back to the hairdresser. He is a lovely flamboyant Italian. “I’ve been doing this job since I was 10 years old”, he told me. “You know why I do it? I love it, it is my hobby, it is my fun.” He snipped around my head theatrically with a large, shiny and sharp pair of scissors, whilst I tried to retract my ears. “You know some people they do this job as a job; they get taught where to cut, how to cut, but they don’t love it. This is fun for me, if there is no fun, why would I bother?”
And of course, that is where we are in Primary Care. It has to be fun. It has to be enjoyable. We do ourselves and our patients a disservice if we operate without passion and without enjoyment for our work. We can though only do that if we have the space and time to properly consult, and to do what we were trained to do all those years ago. So, we have to change, and we need a lot of coffee room chats. Keep talking.
Jonathan Inglesfield
September 2022
The Deer Doctor 