‘We don’t work in isolation’: a GP’s view on impending strikes
GGPs in England have voted to take their first industrial action in 60 years amid a row over funding. More than 8,500 GPs took part in the vote, the BMA said, with 98.3% backing industrial action. Disruption is likely to begin immediately and could last for months.
This is the opinion of a GP in Essex, Dr James Booth.
I have always worked as a GP in Chelmsford. I was a partner until 2021 when I moved to a salaried role. This was partly because I had a period off because my mental health was suffering as a full-time partner. I was working five days a week as a sole partner, often working 14 hour days. I was dealing with 50 or 60 patients a day, on top of the admin, and that was absolutely unsustainable. I think the turning point in our workload was around 2017 or 2018.
Most GP practices are one or two unexpected circumstances away from the end. In my case, my father and I were running a small practice together and he got sick very unexpectedly and had to stop with 24 hours notice – and nobody could do anything about it. And that was the end for us.
We don’t work in isolation; we are connected to the whole of healthcare. So when other parts are struggling, it affects us, like when waiting lists get longer. If a patient is waiting for a hip replacement for over a year, they’re not waiting at home. They’re coming to us because their pain is getting worse and they’re becoming less mobile. If you’re waiting for definitive treatment and you’re on a long waiting list, you’re going to see your GP. That’s a huge driver of demand for us.
It was also harder to recruit GPs to our practice when we had vacancies. Our finances were also under pressure – we found it hard to balance the books in the operating theatre and we relied on putting our own money into the operating theatre to keep the cash flowing. It was incredibly challenging to make the finances work.
I think the difficulties we faced were a combination of the fact that patient numbers were just increasing, and that reflects the fact that we have an ageing population. My practice in Chelmsford, Essex was in a particularly vulnerable area with high levels of social deprivation, and that drove demand.
When I was at my busiest, I would arrive at the surgery at 7am and easily work 13 or 14 hours a day without a break. It was not unusual for me to see between 40 and 60 patients face-to-face in a day, plus phone calls, plus running the operating theatre and other admin every day. It is very easy to lose sight of your own wellbeing in those circumstances.
I ended up having a health scare when I was at work – my colleague really thought I was having a heart attack. I went to the hospital and had an emergency angiogram, and it was a false alarm. But the cardiologist told me I needed to take a couple of weeks off because it was a reflection of stress. But less than a week later I was back at work and working 14 hours a day again, because I couldn’t see any way I could not do that work. I didn’t see who could replace me, and I think that’s a pressure that a lot of GPs feel.
I responded to the overwhelming workload by having a pretty strong sense that I wasn’t doing the best I could for my patients, and that I was somehow letting them and my team down because I was struggling. There was a very real sense that I couldn’t possibly leave, because there would be no one else to do this work if I did.
I felt that because I was the only partner at that time in a practice where I worked with my father for many years. And I think that’s a pretty common feeling for GPs: your practice feels very personal. Everything that happens in the building is your responsibility. I think it was that feeling of constantly trying to match the increasing demand with more and more work.
An analogy is that GPs are like hamsters in a wheel. Our response to the increased workload would be to make the wheel turn faster.
Although I could not vote as I am no longer a GP partner, I would have voted for the action. GPs have been doing an immense amount of work for years without any resources, and if the NHS collapses without that work, then it has never been properly paid for or resourced.