Are female GPs a drain on the NHS?

The future face of general practice is female. Prisca Middlemiss asked an all-women team for their views.

At first glance, there is nothing unusual about Mill Hill Surgery in Acton, west London.

But, with four female partners, a woman registrar and an entirely female staff, this is a woman-only practice. Only the current student is a man.

Today, just 3.5 per cent of practices in England are all-women. But with women outnumbering men at every stage of professional selection - they make up 59 per cent of both this year's registrar intake and of last year's new RCGP members - it is the face of the future.

This 'feminisation of medicine', said West Lothian GP Dr Brian McKinstry, is bad for medicine and bad for general practice. Writing in the BMJ, he recently subjected women GPs to a drubbing.

More often than men, he said, women GPs work part-time, take career breaks to start families and retire early giving a relatively poor return on the state's investment in their education.

With Mill Hill's two full-timers (Dr Kate Cabot and Dr Imogen Measday) on eight sessions a week and two part-timers (Dr Jennifer Durandt on six sessions and Dr Anne Scully on four), he has a point.

But this full-time/part-time balance is no different to any other mixed-gender practice. The current four-woman partnership has accommodated two maternity leaves but not a sabbatical and no-one is planning early retirement.

No men since 1989
The Mill Hill team has been all-women since Dr Kate Cabot joined as a registrar in 1989. In 2001, they appointed a male partner but he was unable to join due to delays in qualification. Since then, they've had just one male registrar.

Dr McKinstry has suggested that women GPs are inefficient. They refer more patients to secondary care and they are long consulters, he says.

Dr Cabot conceded that her team are relatively high referrers but no higher than other local practices in an area with a high level of ethnic and social mix.

As for consulting longer: 'It's never caused any problems and we always see all the patients by the end of the morning. So I can't see why that matters.'

But women do not play a full role in medical life, do they?

Yes, women are underrepresented on political organisations. With a home, husband and a daughter to juggle alongside her full-time work, she 'wouldn't feel happy going out for more than one evening meeting every couple of weeks', said Dr Cabot.

As for teaching and education, the Mill Hill team all teach undergraduates and Dr Cabot is a GP trainer. Their daytime non-clinical commitments are as heavy as any man's.

Self-evidently, there are limitations to what a single-sex practice can offer, like patient choice on GP gender.

'We are very happy to refer to excellent male colleagues down the road,' says Dr Cabot.

Of course female GPs have their strengths.

They are patient centred. A 'good symbol' for the Mill Hill partners is that when they see non-English speakers, they insist on face-to-face double appointments with interpreters.

In short, the Mill Hill team do not believe the service they offer patients is essentially different from any mixed practice. Where they are different is in achieving a better personal work: life balance.

After all, juggling commitments is what women are good at. Flexibility is easier to achieve when you are a partner rather than salaried. Dr Cabot would encourage more women to choose the partner route.

Flexibility is an essential ingredient of professionalism, she pointed out. If the profession loses that autonomy 'you're talking about automatic doctors that just do their bit and go home'.

And no one wants that.

What do you think? Do you work in an all-men or all-women practice? Send your views to

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