On the eve of the election, I called for the new government to respect and support general practice to deliver dignified, quality care to patients by supporting the workforce and improving professional morale. 100 days in, I thought I'd check on their progress.
An ongoing relationship is key to successful outcomes and whole-person care, as a GP you get to know the patient and read between the lines. I don't think the government has taken the case I made in May seriously; and I fear it may already be believing its own rhetoric.
As a GP you learn to gather facts rather than jumping to conclusions. So what's the underlying truth of the health challenges in London?
In 100 days London has spent £36 for every patient registered with a GP. That's a bargain at 36p a day each, and a whole penny cheaper than the national average.
The population of the capital grows by 30,970 people in 100 days, according to Greater London Authority projections. That's almost the capacity of White Hart Lane stadium every 100 days or about four full Routemaster buses every day.
But the critical factor is that whilst patient numbers are growing steadily, GP numbers aren't keeping pace. In fact our own recent research shows we are sitting on top of a three-year timebomb. By July 2018 London could lose as many as ten percent of its GP practices, as overworked, demoralised and burned out GPs decide to leave the profession or even the country.
So having identified the problem, what progress has been made with support for London's general practice, to help rising numbers of patients, with ever more complex, multiple health and care needs? In May I asked the new government to:
Fund every practice properly, invest in community services, let hospitals do what hospitals do best.
Work towards a restoration of trust and goodwill in return for a cull of bureaucracy and an end to hyper-regulation, so doctors have time to look after their patients properly.
Stop trying to integrate organisations and instead coordinate the care that is provided.
Have we seen any of this?
Sadly not - ever more hours are taken from providing care and given over to regulator's red-tape; and vital community services are starved of funds.
So, what's in the government's care plan?
Next day appointments, named GPs and seven day access are great ideas but alone will not deliver improved patient care. Another 5,000 GPs over five years will just about keep pace with current demand, and that 5,000 figure has been revised to a best case scenario. It takes 10 years from medical school enrolment to qualify as a GP, so in a decade we may have one extra GP per UK local authority area.
As community services are cut back and NHS commissioners load more and more tasks onto GPs the frontline service is at risk of buckling to the point of breaking. It's a case of government trying to build two extra stories onto a house, with no bricks, while the foundations are collapsing.
GPs already provide a seven-day service for urgent care, with cover for out-of-hours appointments and home visits. Working Monday to Friday a full-time GP will work an average of 10 hours a day, doing the best for patients regardless of the 10 minute appointment norm. There has been no recognition of this, instead it's implied that GPs are clocking off at five on the dot with a queue of sick patients still waiting.
If the government continues to undermine GPs they will continue to leave. And we know recruitment's a problem, but on the upside what could you get with that extra 36p a day?
26 minutes rent in a £600 per month flat. Unlimited music streaming - a Spotify subscription works out at 33p a day. Seven slices of bread - an 18 slice loaf costs £1.26. A tin of baked beans - which at 25p does come in 11p cheaper than unlimited access to expert generalists from the world's best health system.
It's a gift horse, right?