Public duty. What does that mean? Well, if you're on Twitter, it means #publicduty, with teachers, doctors, lawyers, emergency services, the disabled and many more all warning of the impact of a Conservative win in the upcoming general election.
So what am I trying to do here? Am I trying to reaffirm those of you who already agree with the #publicduty warnings? Or am I trying to persuade a few floating voters who are undecided, that it's worth looking at the stories all these people have shared?
Neither actually. I'm not here to persuade you to vote one way or another. Numerous studies rate doctors amongst the most trusted professionals by the public. We deal in facts and evidence, and see the intimate and personal side of people at their most vulnerable. Here is what I, as an NHS doctor, have seen since the 2010 election. You can make your own judgement.
In 2010 when I arrived for work, I looked forward to my day. My colleagues were happy. Being a GP was a good job, and a job that was sought after and competitive. I had completed extra training to make sure I could stand out from the crowd. I was proud to be a GP, and what I could do for my patients.
In 2017, work is a constant battle. There are not enough doctors or nurses to see the patients. I don't know what the future of general practice is. No young doctors want to join the profession, and my colleagues are leaving in droves. In the last month, five GP friends have left medicine entirely. Another has left the country, feeling no longer welcome as a European after the Brexit vote. We are recruiting doctors from abroad to plug the gap; we are shortening training to get doctors through faster and fill the empty spaces; we are inventing new roles to patch up the crumbling workforce. We are desperate.
In 2010, when my patient came to see me and had two, three or four problems to share in their appointment, I had time. I could focus on them and their health, not distracted by the piles of paperwork and tests results waiting for me. I could give them my attention, and truly listen to what they said. They were my focus.
In 2017, if a patient comes with a list, or more than one problem, the signs in the waiting room tell them no. "one problem per ten-minute consultation", they declare. If they ask to cover something else during our appointment, I must think of the patients who are waiting; the patients who have waited for four weeks already to see me. The mounting number of calls I need to return, and the extra work I must do because there are not enough staff for these patients who need them. I must say no, and watch their face as I damage the relationship between us that I worked so hard to build.
In 2010 if you rang for a home visit, because you were too poorly to come to the surgery, you got one. In fact, if you didn't ring but you were elderly, vulnerable, just out of hospital, or bereaved, I would come and see you anyway. Prevention is better than cure, and being a GP is about looking after patients all the time, and stopping things from reaching a crisis point where they need to go to hospital. Stopping them developing complications that land them in A&E, stopping them falling and breaking a hip because I have time to see their increasing frailty coming.
In 2017 I don't have time to do anything other than urgent visits. Even then, not all of them. Patients ring and ask to be seen at home and we have to say no. We have to ask them to get in taxis, or a relative's car. Unless you are dying, I can't promise that I can see you. Even then, I might not be able to. I must ask the district nurses, who are run off their feet, or the Macmillan nurses who have to choose between which dying patient they see, because there are not enough of them. I feel stretched too thinly, trying to cover impossible gaps, and failing my patients; letting myself and my profession down.
In 2010 if I referred you for a scan, or a procedure, I could tell you confidently you would be seen quickly. I had no doubt you would hear within a few weeks, and often be seen within a month. The local hospitals worked, the days of waiting months for an appointment gone. You couldn't afford to go private, didn't ask and I didn't suggest it. If your symptoms got worse I could pick up the phone and get you seen sooner. The NHS was there.
In 2017, I sigh as I tell you it will be a few weeks before the first letter that says you are on the waiting list. A month or more after that you may get an appointment. That appointment will be in six, 12 or 18 months' time. When your symptoms get worse, I have nothing to offer. No letter from me will make a difference; the hospital doctors are working as hard as they can. You ask how much it will cost to pay privately, but we both know you can't afford it. The painkillers get stronger as we wait, the side effects get worse, you see me again and again, but there is nothing else I can do. You are being failed by a neglected, underfunded system.
In 2010 if I had to admit you to hospital, and you were scared, I could reassure you that it was the best place to be. The doctors and nurses there would be able to care for you in a way I couldn't in your home. You needed more, and you needed them. No-one wants to go to hospital, I would reassure you, but it really is the best place for you now. I didn't give it another thought.
In 2017, I can't say that anymore. When you ask me if you would be better in hospital, sometimes I want to say no. I know the chances are you will wait hours for an ambulance, as the paramedics try desperately to race to the many calls coming in. I know you will sit in the ambulance because there are no beds in the hospital, waiting and distressed. I know you won't have a bed because there aren't any, and you will spend a cold night on a trolley in a corridor. I know at some point a tired nurse who is trying their best will miss their own break to get you a drink. A doctor will have stayed late because there is no one else to cover, and they have already been on-call for 18 hours, with more looming. I know they will try, but they and all the staff are exhausted. They are running on automatic. They will struggle to give you the care you need because they simply don't have the time or the precious resource of enough staff.
My heart sank when the election was announced; I could see a certain inevitability to it all. This is what the last seven years have done to the NHS. This is my honest account as someone who always wanted to be a doctor, who loves talking to patients, helping them with their day to day lives. Draw your own conclusions from this, and ask who has the most to gain from #publicduty. I'm not proud to say I'm not giving the care I want to, and I'm not proud to see my colleagues struggling. I'm not proud to say I may not be a GP in another five years but this isn't what being a GP is. This is firefighting, dodging bullets, and repeatedly letting down the people who need me. What do you do, when the job you love is destroyed around you, and people are getting hurt?
You do your #publicduty.