I believe part of the pressure on A&E stems from the lack of accessible primary care in the community. When it takes two weeks to see a GP or nurse, it's no surprise that people head to A&E just to be seen sooner. I’m not sure why it’s so difficult to establish more Walk-In Centres or to incentivise GPs to offer extended hours, including Saturdays.
Great article - and as a retired GP who left in my mid 50's due to a combination of becoming a carer and burning out, I am interested in how you would 'return retired GP's to practice'. I left feeling disempowered, disillusioned and exhausted and it would take big changes to get me back. There are also many younger GPs who are out of work due to funding being ring fenced for other roles. Giving back the control and funding to practices so they can employ the right people for their teams would increase the number of GPs at the coal face and, more importantly, stop the younger ones from emigrating to countries where the work environment is better for them. And absolutely - as you say - redefining the GP role so they can concentrate on communuty care, holistic care and continuity of care, which is how it felt like it used to be 15 years ago, would be a great start.
Thanks for sharing your story as a retired GP. It's eye-opening to hear from someone who left in their mid-50s due to burnout and caring responsibilities.
I'm really curious - what would actually tempt you back? It sounds like you left feeling pretty worn down and disillusioned, so I imagine it would take some meaningful changes, not just incentives.
That point about younger GPs being out of work because funding is ring-fenced elsewhere is shocking! We're constantly hearing about GP shortages, yet we have qualified doctors who can't get jobs? That seems mad.
I love your suggestion about giving control back to practices so they can build the right teams for their communities. What do you think that would look like in practice?
The idea of helping GPs focus on community care and continuity again sounds spot on. I think many patients miss that relationship-based approach too. Do you think there could be roles where experienced GPs like yourself could contribute without facing the same burnout risks - perhaps some kind of mentoring or part-time clinical work?
Your perspective from having worked during what sounds like a better time in general practice could be really valuable in figuring out how to fix things.
Yes indeed there are a lot of out of work GP's which as you say is ridiculous with the shortage of appointments. I do work in appraisal and mentoring roles now but miss the clinical work. But I can't see myself going back to the intensity and length of days I used to do. Interestingly, the NHS does have a mentoring set-up but the mentoring work is unpaid. I think to fully answer your question would mean a very long response, but I will write an article soon about why I burned out and what an ideal job would look like to me now. Watch this space!
The purpose of medical and educational and regulatory bureaucracy is not to fulfill their primary social missions. That might be the purpose of each individual in the bureaucracy, but the main aim of the organization as a whole is to grow and absorb more resources. That means more administrators, more rules, more paperwork, and an increasing focus on 'problems' (like equity, racism, gender bias, mental health symptoms) that can never really be solved, or even measured.
The solutions for real social problems are usually pretty simple, but they turn out to be impossible to implement. The bureaucracy stands in the way, because the bureaucracy senses a threat to its expansion. For a healthy society the solutions are improved diet, better sleep, and more activity... incentivized. For mental health the solutions are less prescribing and more religion and social connections... incentivized. For organizations like the NHS the solutions are more providers (which means paying providers more, which means fewer administrators) and more nurses. The American VA healthcare system had the same challenges a decade ago. It never solved them. It doesn't want to solve them, and neither does the NHS.
The dream of the system is a chronically ill, lonely, and insecure population without strong families or communities whose every need is managed by the bureaucracy. No person wants this, but those are the systemic incentives we've erected. THAT is how a maximal number of educated professionals make money in our system and it's the place we're moving towards, inexorably.
Interesting theory, but it crumbles when we look at Nordic healthcare systems—similar bureaucracies delivering far better outcomes. If administration is inherently self-serving, why don't all public systems fail equally? The NHS struggles not from bureaucracy's existence but from chronic underfunding and political meddling. Your 'simple solutions' of better sleep and more religion sound suspiciously like telling patients to pray away their cancer while administrators avoid accountability. Ironically, dismissing complex healthcare problems with sweeping generalizations is exactly the kind of oversimplified, untested thinking you criticize. What specific, proven reforms would you actually implement?
I believe part of the pressure on A&E stems from the lack of accessible primary care in the community. When it takes two weeks to see a GP or nurse, it's no surprise that people head to A&E just to be seen sooner. I’m not sure why it’s so difficult to establish more Walk-In Centres or to incentivise GPs to offer extended hours, including Saturdays.
Couldn't agree more! I have found the 111 number to be somewhat helpful and generally a good idea to deal with non emergency situations.
Great article - and as a retired GP who left in my mid 50's due to a combination of becoming a carer and burning out, I am interested in how you would 'return retired GP's to practice'. I left feeling disempowered, disillusioned and exhausted and it would take big changes to get me back. There are also many younger GPs who are out of work due to funding being ring fenced for other roles. Giving back the control and funding to practices so they can employ the right people for their teams would increase the number of GPs at the coal face and, more importantly, stop the younger ones from emigrating to countries where the work environment is better for them. And absolutely - as you say - redefining the GP role so they can concentrate on communuty care, holistic care and continuity of care, which is how it felt like it used to be 15 years ago, would be a great start.
Thanks for sharing your story as a retired GP. It's eye-opening to hear from someone who left in their mid-50s due to burnout and caring responsibilities.
I'm really curious - what would actually tempt you back? It sounds like you left feeling pretty worn down and disillusioned, so I imagine it would take some meaningful changes, not just incentives.
That point about younger GPs being out of work because funding is ring-fenced elsewhere is shocking! We're constantly hearing about GP shortages, yet we have qualified doctors who can't get jobs? That seems mad.
I love your suggestion about giving control back to practices so they can build the right teams for their communities. What do you think that would look like in practice?
The idea of helping GPs focus on community care and continuity again sounds spot on. I think many patients miss that relationship-based approach too. Do you think there could be roles where experienced GPs like yourself could contribute without facing the same burnout risks - perhaps some kind of mentoring or part-time clinical work?
Your perspective from having worked during what sounds like a better time in general practice could be really valuable in figuring out how to fix things.
Yes indeed there are a lot of out of work GP's which as you say is ridiculous with the shortage of appointments. I do work in appraisal and mentoring roles now but miss the clinical work. But I can't see myself going back to the intensity and length of days I used to do. Interestingly, the NHS does have a mentoring set-up but the mentoring work is unpaid. I think to fully answer your question would mean a very long response, but I will write an article soon about why I burned out and what an ideal job would look like to me now. Watch this space!
Looking forward to it!
You might want to follow DAUK to learn more about these themes - I think it would complement what you are covering.
https://substack.com/@dauk
Thanks for the recommendation - we are following them now!
The purpose of medical and educational and regulatory bureaucracy is not to fulfill their primary social missions. That might be the purpose of each individual in the bureaucracy, but the main aim of the organization as a whole is to grow and absorb more resources. That means more administrators, more rules, more paperwork, and an increasing focus on 'problems' (like equity, racism, gender bias, mental health symptoms) that can never really be solved, or even measured.
The solutions for real social problems are usually pretty simple, but they turn out to be impossible to implement. The bureaucracy stands in the way, because the bureaucracy senses a threat to its expansion. For a healthy society the solutions are improved diet, better sleep, and more activity... incentivized. For mental health the solutions are less prescribing and more religion and social connections... incentivized. For organizations like the NHS the solutions are more providers (which means paying providers more, which means fewer administrators) and more nurses. The American VA healthcare system had the same challenges a decade ago. It never solved them. It doesn't want to solve them, and neither does the NHS.
The dream of the system is a chronically ill, lonely, and insecure population without strong families or communities whose every need is managed by the bureaucracy. No person wants this, but those are the systemic incentives we've erected. THAT is how a maximal number of educated professionals make money in our system and it's the place we're moving towards, inexorably.
https://jmpolemic.substack.com/p/leviathan
Interesting theory, but it crumbles when we look at Nordic healthcare systems—similar bureaucracies delivering far better outcomes. If administration is inherently self-serving, why don't all public systems fail equally? The NHS struggles not from bureaucracy's existence but from chronic underfunding and political meddling. Your 'simple solutions' of better sleep and more religion sound suspiciously like telling patients to pray away their cancer while administrators avoid accountability. Ironically, dismissing complex healthcare problems with sweeping generalizations is exactly the kind of oversimplified, untested thinking you criticize. What specific, proven reforms would you actually implement?