THE BLOG

Have Doctors Become Drones?

23/04/2015 12:42 BST | Updated 21/06/2015 10:59 BST

Just why do doctors retire early? After all the role of a doctor, to all outward appearance, would seem to be one to die for. There's the prestige to start with. And the money's not bad. The hours have certainly improved since the removal of 24 hour responsibility for patients in 2004. You are your own boss. There's job security of course. And a decent pension. Commuting times are minimal. It's intellectually stimulating. It might even be considered to be a rewarding job that does some good for both individuals and society at large. Yet no-one seems to want to do it. How can that be?

It has been well documented over the past months that there is yet another crisis in GP manpower with established GPs retiring early coinciding with fewer trainees wishing to take their place. Those that are in post are disillusioned. Morale within the profession has never been so low. Yet this is not the first time that primary care has faced such a scenario/crisis. The last time these malevolent planets were aligned was in 2003, just prior to the new GP contract of the following year. At that time GP morale had plunged to previously unforeseen depths with doctors desperate to leave work early before they themselves died prematurely of burn-out related conditions.

The main issues driving this discontent were the long hours associated with the onerous out of hours duties undertaken by the vast majority of doctors and poor income, particularly with regard to other profession groups such as lawyers, dentists etc working outside the public sector. When these were addressed in the negotiated contract you could almost feel the hurricane of relief exhaled by grateful GPs and there is no doubt that many stayed as a consequence of the contract who would otherwise have retired early. In effect the NHS had bought itself some breathing space in community care but why did that space become so short-lived?

Beware the law of unintended consequences. GP partner income unarguably, significantly increased in the two years following the 2004 contract. A small part of that increase was due to partnerships choosing to employ sessional/salaried doctors rather than replace or increase partner numbers. Salaried doctors had defined hours and duties set by their employer. They were no longer professionally autonomous. They had become medical drones. And they were cheaper. At that time doctors entering general practice were frustrated by having the traditional route through a career in family practice i.e. that of a partnership, closed off to them.

However subsequently something unexpected began to take hold. They began to appreciate the trade-off between income and responsibilities. They found that they had a better quality of life despite a lower income than their peers in partnerships. The idea of a salaried career gained traction and has since, arguably, become the path of choice for new entrants into general practice.

Meanwhile GP partners found that in return for a larger income they had relinquished control over their own independence. Year by year the NHS, through its various local management structures and including those set up by doctors own professional bodies, increasingly dictated how GPs should run their day to day activities. Surgery opening times, appointments, consultation times, hospital referrals, clinical activities, education, drug lists- all were being micromanaged and scrutinised. Even clinical software for patient management glared from terminal screens on desks like a malign Stasi dictating what the doctor could and could not do.

All semblance of independent practice has been stripped away from GPs over the past decade. They are now remotely controlled. GP partners too have become medical drones.

Doctors are not stupid people. Their disillusion has been brought about by recognition that they have been duped and that that duplicity has been partly self-inflicted. If they cannot rectify the situation then they have only two choices; to rebalance the equation between independence and income and to become salaried NHS employees or, to retire.