Confessions of a GP

The other aspect that needs to be remembered is that, although our wages are ultimately taken out of NHS coffers, GP surgeries are actually small, privately run businesses, making their own management decisions about pay, services, appointments and the day-to-day running of the practice. They do, of course, have to follow a huge number of regulations that are provided by the PCT and Whitehall, but they are still autonomous in many respects. As with all businesses, if the GP surgery works effectively and efficiently, it will earn more money. The practice will also get money if it branches out and provides new services such as minor surgery. The partners can then decide how that money is spent. They can choose to spend the money on improving the practice, or they can pocket the cash themselves. To be fair, most GPs have done a bit of both. Carrots are being dangled to GPs and for those who have the motivation and energy to set up new services and reach targets, the high wages are there for the taking.

Many of the extra services that can now be provided by GPs are being taken from hospitals. For example, the PCT might decide that they are paying too much money to the hospital to provide vasectomies. The hospital may have been providing vasectomies for years, but running any service from a hospital is expensive. The hospital is not interested in profit, so may well be running a fairly inefficient service. A GP might see the opportunity to undercut the hospital by training himself to do vasectomies and performing them at his surgery instead. He will then be slated in the press for earning loads of money, but by undercutting the hospital he will actually have saved the NHS considerably more than he earns. The GP is being well paid but has taken on a new responsibility and skill. He is also taking the risk that the service he is providing might be undercut by somebody else in the future.

This may all leave a slightly unsavoury taste in your mouth and I certainly didn’t expect to have to get involved in the competitive cut-throat world of business when I chose to become a doctor. A few good GPs have rejected all of these modern changes and instead just do what they have been doing for years. They ignore targets and simply stick to trying to do the best they can for their patients. These are the GPs who don’t earn as much money but have an honest wholesome glow about them. Good for them, but they are slowly being forced out of general practice as the brave new world order takes over.

As a young and sometimes still idealistic GP, I am trying to work out how to play the game. I want to make a good living but not let the greed and madness of medical politics engulf me. I will probably become a salaried GP. These doctors are employed by partnerships and earn a set wage for a set number of hours. They don’t take a share of the windfalls acquired by meeting targets, but they do often do a lot of the work to reach those targets. They earn about £60–70K per year and avoid a lot of the bureaucracy and paperwork that the partners have to put up with.

Angela

One Saturday night I was working for the on-call GP service again. I was sitting in a small cold Portakabin in the main hospital car park and was covering the emergency GP calls for the entire town. I didn’t know any of the people calling up but most of the problems could be dealt with over the phone and if not I could always drive round to do a home visit.

It was actually a fairly stress-free evening and after calls reassuring a couple of first-time mums and a brief visit to see an old lady with a urine infection, I was almost ready to go home. It was nearly 11 p.m. when the phone rang and I decided to take a last call:

Patient: May I ask who I’m speaking to?

Me: Certainly. My name is Dr Daniels. How can I help this evening?

Patient: Hello, Dr Daniels. My name is Angela and I’m going to kill myself right now and it’s all your fault.

At this point the phone went dead. I tried to phone her back but the line was permanently engaged. The computer flagged up her telephone number and address but nothing else.

I had never met Angela before but apparently I was about to become responsible for her death. Even at my most narcissistic, I knew that I was unlikely to be important enough to single-handedly inspire the suicide of a complete stranger. I also very much doubted that Angela had any intention to actually die. The problem was what did I do now? I knew absolutely nothing about her. My gut instinct was that she was probably just a time-waster and the best thing to do would be to completely ignore her.