Future of general practice: Next generation of GPs has much to be positive about

Dr Thomas Abraham reflects on more than two decades in general practice and how times have changed between the start of his career and that of his daughter Rowena, who recently joined him as a member of the RCGP.

Dr Thomas Abraham with his daughter - and fellow GP - Dr Rowena Abraham
Dr Thomas Abraham with his daughter - and fellow GP - Dr Rowena Abraham

In 1992, Presidents Bush and Yeltsin proclaimed the end of the Cold War, the Queen celebrated her Ruby Jubilee and Princess Anne married Sir Timothy Laurence. That same year, as a humble mortal, I started general practice in the biggest council estate in Europe - in Bransholme, Hull.

At that time, getting into general practice was competitive and most people took three years to scale the winding, serpentine step ladder towards becoming a full partner. It was a game of thorns and thrones.

Many practices were not computerised. In our practice, consultations were hand-written on Lloyd George cards. As part of the daily routine, I saw about 30 to 36 patients in the morning at five-minute intervals. The consoling conclusion brought a meeting with pleasant medical representatives who were generous with freebies and at times free lunch as well.

Weekend GP opening

Prescriptions, administration and three or four home visits filled the midday gap. In afternoon surgery, I used to see about 24 patients. We did Saturday morning surgery as routine.

The location of my practice was one of the most socially deprived areas, characterised by frequent vandalism, doctors’ cars being broken into, smashed up street lights, a high rate of teen pregnancy and drug misuse.

In spite of the adversities, the patients held much respect for doctors; complaints were few and far between. Fundholding came into place, and with changes in the GP contract, the out-of-hours cover was gradually passed onto GP co-operatives. One of the pleasant experiences was attending educational meetings held in exotic Golf Hotels.

Recently, my daughter Rowena Abraham was awarded membership of the RCGP. She is entering an arena marked by a battery of contrasting, complex challenges. Patient expectations and demands have rocketed; the profession is constantly under multi-pronged attack from the press, politicians and public.

The internet revolution has made many patients feel that they know best, and there seems to be a generalised lack of respect towards the profession. Meanwhile, the trans-atlantic wave of litigation is spreading like wildfire. In five years’ time, a third of GPs will be retiring. There are too many shepherds controlling the herd from various angles - CCGs, NICE, the GMC, the CQC.

Quality general practice

But there are positives to hang onto for GPs in my daughter's generation. Albert Einstein once remarked: 'It has become appallingly obvious that our technology has exceeded our humanity'. With the advent of modern technology, to some extent, this is applicable to general practice. All practices are computerised; appointments slots are at least 10 minutes, the approach to investigations is better and quicker, we have seen remarkable improvements in cancer care, better educational opportunities and rigorous appraisal/revalidation.

And under plans set out in the GP Forward View, the government has pledged £206 million to tackle the 5,000-GP recruitment target, an increase in GP funding of £2.4bn  a year by 2020/21 and £500m recurrent funding to support the rollout of seven-day access. These plan could improve access and create more time to allow better care for patients.

GPC chairman Dr Chaand Nagpaul has recognised these plans as ‘a significant and comprehensive package of proposals’.  There are concerns from various corners regarding the lack of detail and doubts about whether elements of the funding package will reach practices, or be delivered in time to help. Some argue that we need over 15,000 more GPs - far more than the government has promised. But on balance, this is a positive turning point for general practice.

Passing the torch to the next generation is a protracted, painstaking but productive phenomenon. When you run the relay and pass on the baton, there is a sense of optimism that the person running the next stage of the race can run faster than you did, and become a winner. I hope the coming generation can realise what is good about general practice, benefit from the coming wave of investment and stay around to look after that baton for some time.

  • Dr Abraham is a GP in Hull

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