Managing Uncertainty

It’s often said that GPs are the jazz musicians of doctors: improvisation and managing uncertainty are part of daily professional life in primary care, and this is what makes the job so rewarding. But this year things got significant more uncertain: national politics have created a such a dense metaphorical fog around the future that makes that makes it hard to plan for the future of the NHS and primary care on both macro and micro level. The BMA poll last year showed half of the UK’s 12,000 EU doctors are considering to leave, while one in three of my colleagues in primary care are considering hanging up their stethoscope within the next five years, independent of their nationality. Then there are the concerns around the sustainability of provision of medicines (at present there don’t seem to be any naproxen and 40mg furosemide tablets available), isotopes for imaging machines, the severe shortage of nurses and paramedics. The list is endless. My beloved NHS -and particularly primary care – is getting severely battered, and it feels like it is only kept (barely) working by the good will of its workforce. Which seems to be wearing thin. I find it unlikely that the ban on fax machines is going to change this.

After so much moaning let’s just remind ourselves how important the GP model of the NHS is for the communities they serve: Barbara Starfield, professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore consistently showed that having a primary care practice in your community, even after correction for socioeconomic factors, results in lower all cause mortality; lower mortality from cancer, heart disease, and stroke; increased life expectancy and better self reported health; lower rates of admission to hospital; lower infant mortality; reduced health inequalities; and reduced costs (Caley, M. (2013) BMJ). I find it unlikely that you can deliver these benefits if you shift consultations to online providers.

/rant over. If you’re lucky and you have a few days off over the primary gifting season, enjoy them. If you -like me – have to work between Christmas and New Year, I wish you luck, nerves of steel and understanding patients.

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