IF we are going to deal with the crisis in GP services that has featured in these pages during the last week (Letters, April 20, 22, 23 & 24), the medical profession needs to tell the politicians exactly what is needed.
So here goes.
Scotland has a population of 5,295,000 (2011 census). The GP workforce amounts to 3735 whole time equivalents (WTE)( Information Services Division Scotland Primary Care Workforce Survey 2013). The average list size by these figures is 1418. It's too much. General practices are overworked and understaffed.
The secret of a long and happy life in general practice is to look after a flock of no more than 1000 souls. You will seldom have more than 100 consultations in a week, you can see every patient on the day the appointment is arranged, and you can give the patients all the time in the world. If you schedule 15 minute appointments you will run to time.
You can also collaborate with colleagues in your own and in neighbouring practices to take on a modest and supportable burden of out-of-hours work, and still be left with sufficient energy to pursue special interests, research, and continuing education. The profession can help itself here by dumping - in its entirety - the target-driven tick-box culture that has threatened to destroy it over the last decade.
To facilitate all this, the WTE GP workforce needs to be increased from 3735 to at least 5295. We therefore need to train far more doctors. This involves a radical change of mindset both for the profession and the public.
The profession needs to stop thinking of itself as an exclusive club. At the moment, if a school leaver wishes to study medicine, he or she needs not only to have acquired a plethora of top-grade exam results, but also to demonstrate that they have gone to West Africa and solved the Ebola crisis single-handed. We need to increase the undergraduate intake at medical school. Most of the people who wish to study medicine never get the chance.
The same argument could be put forward for virtually every medical specialty. The length of time a patient will wait for an outpatient neurology appointment has passed beyond the absurd and into the surreal.
All professions are conspiracies against the laity, said George Bernard Shaw. Contrary to medical propaganda, you don't need a giant brain to be a good doctor. You do need a sound understanding of pathophysiology; but you also need to be kindly, caring, and conscientious. And not too preoccupied with money. You might not get rich looking after your manageable flock, but you have a chance of happiness.
Dr Hamish Maclaren,
1 Grays Loan, Thornhill, Stirling.
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