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On Thursday, GPs in England voted to stage industrial action for the first time in 60 years amid a row over funding. More than 8,500 GPs took part in a vote, the BMA said, with 98.3% backing collective action. The disruption is likely to begin immediately and could last months.
Here is the view of one 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 ended up having a period of time off because my mental health suffered as a full-time partner. I was working five days a week as the only partner and was regularly doing 14-hour days. I was dealing with 50 or 60 plus patients a day, alongside admin, and it 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 reaching the end. In my case, me and my dad ran a small practice together and he became very unexpectedly ill and had to retire with 24 hours’ notice – through no fault of anybody. And that was the thing that tipped us over.
We don’t work in isolation; we’re interlinked with the whole health service. So if other parts are struggling that has an impact on us, such as when waiting lists go up. If a patient is waiting over a year for a hip replacement, they don’t sit at home waiting. They come and see 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 will go and see your GP. That is a huge driver of demand for us.
It has also been harder to recruit GPs to our practice when we have had vacancies. Our finances were also being squeezed – we were finding it difficult to balance the surgery books and we were relying putting our own money into the surgery to keep the cashflow going. It was incredibly challenging to make the finances work.
I think the difficulties we faced was a combination of the sheer numbers of patients going up, and that reflects the fact that we have an ageing population. My practice in Chelmsford, Essex, was in a particularly vulnerable area with a high level of social deprivation, and that drove demand.
When I was at my busiest, I would get to the surgery at 7am and work without a break easily for 13 or 14 hours every day. It wouldn’t be unusual for me to see between 40 and 60 face-to-face patients in a day, plus phone calls, plus running the business of the surgery and other admin every day. It’s very easy in those circumstances to lose track of your own wellbeing.
I ended up having a health scare while working – my colleague genuinely thought I might be having a heart attack. I went to the hospital and had an emergency angiogram, and it was a false alarm. But I was told by the cardiologist that I needed to take a few weeks off as it was a reflection of stress. But I was back at work less than a week later doing another 14-hour day because I couldn’t see any way I couldn’t not do that work. I couldn’t see who could replace me, and I think that is a pressure a lot of GPs feel.
I responded to the overwhelming workload by feeling a quite significant sense that I wasn’t doing the best 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 could not possibly go off, because there would be no one else to do this work if I did.
I felt that because, at that point, I was the only partner in a practice I worked at for years with my dad. And I think this is quite a common feeling for GPs – your surgery feels very personalised to you. Everything that happens in the building is your responsibility. I think it was that sense of constantly trying to match the increasing demand with more and more work.
An analogy is that GPs become like a hamster spinning on a wheel, and our response would be to the increased workload would just be to spin our wheel faster.
Although I couldn’t vote as I am no longer a GP partner, I would have voted in favour for the action. GPs have been providing an immense amount of un-resourced work for years, and if the NHS is going to collapse without that work then it has never been properly paid for or resourced.
As told to Tobi Thomas
English (US) ·