Finding a GP is going to become as hard as finding a dentist unless we act. Trust me, I should know

Recently I was asked to speak to future medical students at a Step into Medicine conference. These types of invitations are always welcome, a great chance to talk about the joys and benefits of being a GP. Never before in my 24 years of practice have I wavered, struggled to think what I would say.

Those who know me know I am a belligerently positive person, exuberantly ‘selling' the joys of being a GP. The issue is, I always tell my young children, you need to tell the truth and yet there I am, year on year, crossing my fingers behind my back as I stand up and say this is the best job in the world.

The truth is it’s getting harder to wear that smile. There’s a palpable shift in this post-pandemic era. Patients are frustrated and fed up, many have been on waiting lists for years. They wait in pain and struggle with work or sick lines amid cancelled operations and delayed appointments. It’s no secret we have a perfect storm brewing: a steadily ageing population, with multiple illnesses and morbidity, longer hospital waiting times, and fewer GPs.

The wait to see a GP looks set to become a longer one with falling numbers and an ailing, ageing population (Picture: Anthony Devlin/PA)

Poorer health, wider inequalities

Scotland’s population is slipping from poverty to deeper poverty. Child poverty is rising steeply, with experts documenting the impact of UK austerity measures on deprivation and even the falling average height of our children. We’re becoming a nation with poorer health and wider inequalities.

On one hand, we have promises from the Scottish Government of 800 new GPs on the horizon. However the reality is that the number of GPs we have, by headcount or whole-time equivalence, is now going backwards. We have also had lots of increases in practices’ running costs: like service-level agreement maintenance hikes, rising energy bills, locum session costs, and lease issues.

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We have a leaking staff pipeline, with fewer domestic medical students, more students leaving the UK, fewer UK-trained GPs choosing to stay. We have increased numbers of international medical graduates in GP-training positions, but retention of these doctors is an issue. Problems with visas, accommodation, and other practical factors can reduce their desire to stay here after their training. We have a demoralised and exhausted GP-trainer workforce, continually asked to do more with less.

We may think we’re sleepwalking into a GP disaster akin to the situation in NHS dentistry but the reality is those working in primary care are wide awake and this isn’t a bad dream. The Royal College of General Practitioners and British Medical Association have been flagging concerns for years.

This is a daily reality, not a remote concept. And we need those who may be asleep to wake up and fight for the funding of primary care so we can continue to have a free and fair health service for all. We need people to write to their MSPs in support of primary care and use their health service wisely.

Activism required

Primary care is traditionally exceptionally good value; we deliver 90 per cent of healthcare with ten per cent of the health budget, seeing nearly 30 million patients a year. A million patients contacted NHS24 across Scotland in the last year. All this with a decade-long shrinking workforce while the Scottish population increases and ages.

Perhaps it’s time for a more activism in the face of this impending doom. We need political and public engagement; we need a ‘National Conversation’ to explore public expectations of what the NHS can realistically deliver given current resources and workload; we need to inherently protect continuity and excellence in patient care.

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As part of Pass the Mic, a national programme focused on amplifying women of colour’s expertise, I recently heard that the idea of being an apolitical, impartial expert is only afforded to those in a position of privilege, a stance we can only take if the matter doesn’t directly affect us.

It’s easier to be a peacekeeper, just as it’s easier to blame your GP or practice. My natural default is to keep the peace but now it’s time for a call to arms, to engage the public in preserving a primary care system that’s fit for purpose and properly funded. It affects us all and not one person will escape the collapse of primary care as we know it.

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The Scottish Government has produced excellent guidance on value-based health and care. We are encouraged to abide by the principles of realistic medicine and give patients the right place and right care – guidance is welcome, but the single best way to do this is to have people seen by a properly resourced team that knows them, with adequate, tailored services that keep them out of hospital.

Still no job like it

So, what do I tell school students? The truth is that, despite the white noise and continuous constraints, I firmly believe there is absolutely no job in the world like it. In one surgery, you can support a patient who’s just buried their grandchild, diagnose a new heart condition, use your detective skills to pick up a cancer, and check on a six-week-old baby who makes you smile so widely.

There is no replacement for the conversational nature of our job, we need to be expert communicators with excellent detective skills and common-sense approaches to healthcare. There's no replacement for those kinds of skills. So when it comes to speaking to young people considering medicine as their vocation, I will be honest and congratulate them on doing so despite worsening pay and job conditions.

If we want to train, and most importantly retain, the brilliant minds of the young in primary care, we can only do that by financially supporting primary and social care properly. In turn, the role of a GP will become more attractive and sustainable, creating a strong future workforce that’s fit and able to serve our Scottish population.

Dr Sigi Joseph is an NHS GP of 24 years who has educated over 1,000 Scottish GP trainees. She is an elected member of the Royal College of General Practitioners’ Scottish Council. This article contains her personal views