Without action, general practice faces extinction | Letters

Dr Tom Holdsworth describes a perfect storm for general practice (GPs are the overlooked crisis in the health service. If we fail, so does the NHS, 20 September). Increased demand due to demographic changes, austerity and a pandemic, combined with GP attrition and low recruitment, have led to patient disaffection and loss of trust. His claim that GPs are the bedrock of the NHS may still be the case, as it was in our day, but general practice may not be as irreplaceable as he suggests. Relinquishing out-of-hours services and an emergency role for many conditions has led to other agencies such as 111, out-of-hours providers, paramedics and A&E stepping in.

General practice is at risk of being sidelined to become a specialty of community medicine, dealing with chronic disease and preventative medicine only. As retired GPs, looking ahead to our declining years, we are fearful that the level of care we were fortunate enough to be able to provide for our frail and vulnerable patients will no longer be there for us and our contemporaries.

What can a practising GP do about it? The government does not appear to have primary care on its agenda and there are other models of care circling to take advantage of its demise. We suggest a “rewilding” of general practice that involves focusing on compassionate care and the prioritising of needs over targets, guidelines and all the other things that get in the way, so that trust might be reestablished and general practice might become a rewarding and attractive job again.

It’s a radical suggestion and has attracted some opprobrium, but also some support. It chimes with the American physician Victor Montori’s campaign to “rethink medicine” on compassionate lines in a country with a far more degraded system than ours. Maybe it’s worth considering. As they say of the climate crisis, doing nothing is not an option if we want to avoid general practice becoming extinct.
Dr Lyn Jenkins Retired GP, Chesham, Buckinghamshire
Dr Aneez Esmail Professor of general practice, University of Manchester
Dr Iona Heath Retired GP and former president, Royal College of General Practitioners

The debate about how to manage access and appointments in general practice has been going for years within the profession itself. It has no simple answer. There are not enough of us. When you offer more of one thing, you must offer less of the other. It keeps us up in the small hours, our brains trying to solve the unsolvable.

At its best, general practice is incredible in its adaptability, efficiency and versatility. During the pandemic, many practices have been “flexing” their access system day by day and patient by patient. There are many things to consider: Covid case rates and changing guidance, staff resources and skill mix on any given day, patient factors and resources such as age, frailty, clinical vulnerability, language, literacy, poverty, to name but a few.

We are operating in an increasingly airless atmosphere, where this debate is plastered on newspaper headlines, in danger of policy being made on the basis of political expediency and the whims of ministers. With no prospect in the near future of more staff or resources, our only hope is to use the specialist knowledge of our own populations to work flexibly to provide the best clinical service we can in a resource-poor setting. Recent headlines screaming at us are threatening to take even that away.
Dr Charlotte Bryson

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