The lean and mean GP machine

Well, it’s all over for another year. The helter-skelter chase for points is complete, we’ve hung the tag on its toe and gratefully closed the door.

We aren’t even waiting to see the corpse incinerated because next year we know there will be another set of absurd targets, with the extra and utterly ingenious incentive of no associated pay rise.

It’s clear what happened, of course: the government completely underestimated us.  They set us a series of hoops to jump through, expecting us to collapse in a heap in the middle of the course, the same way hospitals do; they are so out of touch they didn’t realise how different general practice is from the hospital sector.

Hospitals aren’t there to look after patients any more; they have lost sight of their real function and have become like living creatures, whose only purpose is to grow bigger and expand. The most important measure of a hospital’s success is how many more staff have been hired, how many new departments have been opened and how many state-of-the-art scanners have been bought (probably after a local fund-raising drive, which amazingly people still support, considering that I’ve never seen anyone actually cured by a scanner).

They are encumbered by bureaucracy, crippled with inertia, emasculated by administration and over laden with multiple hierarchies, all of whom have different empire-building agendas.

General practice is a different, slimmer, more effective, more streamlined beast, a beast with a lean and hungry look, a beast with a can-do attitude. There is no great secret to our success. It’s very simple; the people who are on the ground, looking after patients directly, are also in charge of management. We may sit in the surgery every day, but we also set the policy, not some faceless, constipated bureaucrat four buildings and five stories away. We get things done, we have the dynamism, the flexibility and ability to innovate.

Up until recently we also had the discretion to decide what was important and what wasn’t, but this discretion is slowly being eroded by our new contract. Consider, as an example, the questionnaire (PHQ9) which we are required to administer to at least 90 per cent of patients with clinical depression. People who are genuinely depressed but are gamely struggling against it may not even break 10. Those swinging the lead and more experienced at playing the game and working the system, however, will score a maximum 27, no problem. It is an open invitation for malingerers, a playground for the manipulative.

PHQ9? R2D2 would be more useful. 

Dr Farrell is a GP from County Armagh. Email him at

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