Public satisfaction with GP services has fallen to its lowest level since records began in 1983, according to the annual British Social Attitudes survey. www.bbc.co.uk/news/health-43213896 As a GP I have experienced first-hand how the job has changed since I first started my primary care training in 1999. In the last 7 years our workload has increased by 16%. We are seeing more patients per day than ever, patients are consulting us more often, ands work that traditionally was done in secondary care is now being transferred back to primary care without the associated increase in resource that was promised. GPs are... Read More

  I remember a middle-aged factory worker in my surgery a few years ago. He was distraught – his wife had just left him. “I can’t understand it” he said, “I gave her everything she wanted” he said, staring into the distance. “I worked every hour of overtime possible – evenings and weekends – so she could have nice things”.   Recently the PCSG secretariat and I and  been working to finalise the programme for the Annual Scientific meeting. The process is like standing on a surf board in choppy seas. Some speakers say they can come and then change their... Read More

When some VIPs were being shown round the NASA launch site for the Apollo mission, they came across a man sweeping the floor. When they asked him what he was doing he replied “I’m helping to put a man on the moon”. I came across this possibly apocryphal anecdote when I was clearing out my desk. It had been used by a NHS leadership fellow, who I was mentoring, to argue that the core of leadership was being able to have a vision and inspire people to share it. In the same purge I found a copy of the Primary... Read More

Patients don’t read gastroenterology textbooks. They feel symptoms and sometimes tell their doctors about them. The doctor then pigeonholes what is presented into a diagnostic box and, if they are not sure, uses increasingly invasive and reductionist investigations to force the information into a labelled box. Ideally evidence of a structural abnormality is found; a breakage, an error that everyone can see must be the cause of the patient’s symptoms. If no concrete cause for the symptoms is found by the doctor, the patient must be at fault. The term ‘functional’, itself newspeak for non-functioning, is used and usually in... Read More

At a meeting recently a senior gastroenterologist asked me archly, ‘Can I be cynical and say GPs don’t prioritise gastroenterology because it is not included in the QOF?’ Actually that is not being cynical (but displays a naivety about how incentives work). While we can try to hold out against tick box medicine, it comes at a price to our practice incomes – and therefore those of our staff as well as ourselves. The QOF has been a remarkably effective tool for changing GP behaviour. These changes have occurred within the consulting room and beyond. They may have resulted in... Read More

The Primary Care Society for Gastroenterology. The clue’s in the name: it’s about primary care and gastroenterology. At the moment primary care in the UK is on its knees. Workload up, profits down, drowning in targets and paperwork. This is more than the usual ritualistic shroud waving which is a necessary part of negotiation in the health service. We’ve been here before in the years immediately before the reforms that brought in fundholding and then the new GP contract (saying this is worse than those times doesn’t help and reminds me of arguments about whether renal colic is more painful... Read More