Can GPs resist the tide of change?

Employers love to have a good moan about GPs and their apparent willingness to sign workers off sick at the drop of a hat.

But if the latest signals from government are anything to go by, it is not inconceivable that employers may have to find something else to gripe about in years to come. Pressure for change is now building on family doctors from a number of powerful quarters.

In September, the Confederation of British Industry (CBI) launched a fierce attack on what it called the UK’s “outdated and rigid” family doctor service, complaining that general practice had little appreciation of, or interest in, the needs of employers to get people back to work.

Calls for change

It called for changes such as easier switching between practices, more flexible, patient-friendly opening hours, and for people to be able to register at more than one practice, so they could, if necessary, visit a doctor near work as well as home.

It suggested one in three adults found it difficult to get an appointment at a time convenient to them, and cited a survey by Boots estimating that 3.5 million working days were lost because of this, costing the economy £1bn.

Also in September, the Sainsbury Centre for Mental Health accused GPs of being over-eager in signing people with depression off work, making it more likely they would end up as long-term unemployed.

Sticking his oar in too was professor Michael O’Donnell, chief medical officer of disability insurer Unum, who argued that, by being too free with sicknotes, GPs were contributing to a far higher number of unnecessary absences from work.

For a profession with a hide as tough as a rhino, such attacks are, of course, mere pin pricks, and the response from GPs was robust. Dr Laurence Buckman, chairman of the British Medial Association’s (BMA) GPs committee, effectively told employers to stop whingeing and invest in a properly funded occu­pational health service.


“The CBI and its members should put their own house in order before trying to heap the blame on general practice,” he said. “If employees lose time from work to see their doctor, it is either because they are ill and need care, or because their employer has insisted they get a sicknote even for a temporary illness which has passed.”

But it remains to be seen how long doctors can resist the tide, and it is increasingly clear that it is employers, not GPs, who have the government’s ear. Last month’s Our NHS, Our Future interim review of the NHS by surgeon and health minister Lord Darzi echoed many of the CBI’s recommendations.

Announced by none other than prime minister Gordon Brown himself, so highlighting its importance to the government, it recommended that at least half of GP surgeries should open during evenings and weekends, and that funding be made available for 150 easily accessible health centres – some run by private companies – which would be open seven days a week from 8am to 8pm.

And it may not stop there. There has been speculation that the review of workplace health currently being carried out by director of health and work Dame Carol Black and due to report in January will include a proposal for ‘back-to-work teams’ to be located in GP practices. These could include nurses, physiotherapists, employment advisers and psychologists.

Black was even quoted in the Daily Telegraph as saying: “Too often, doctors reach for a sicknote when what is needed is some quick therapy, to agree adjustment to their working life, and to get them back to work.”

Certainly, there is now what is sometimes called in American presidential election campaigns ‘big mo’ (momentum) for change.

Andy Bell of the Sainsbury Centre for Mental Health says: “There is a very strong likelihood that change is going to have to come, but there is no point pushing and chastising GPs about this.”

Future outlook

It is virtually inevitable that health at work will become a more important part of the GP landscape, agrees Dr Sayeed Khan, GP and chief medical adviser at the engineering and manufacturing employers organisation EEF.

The Royal College of General Practitioners (RCGP), in conjunction with the EEF, ran a series of half-day workshops for GPs on workplace health issues over the summer that proved hugely popular, he points out.

“We have been trying to get the RCGP to put a specific section in its new training syllabus on health at work,” says Khan.

“That hasn’t happened, but the mere fact they are starting to do some training means that it is just a matter of time before it becomes a proper part of the syllabus.”


Indeed, as evidenced by the more conciliatory tone taken by Dr Richard Vautrey, deputy chairman of the BMA’s GPs committee in response to Lord Darzi’s report, even the BMA now appears to be accepting that change is coming, like it or not.

“The best way to develop a first class NHS is to sit down with patients and representatives of the BMA to decide how to tailor services to meet their needs. We have expressed a willingness to do this on many occasions, and we hope the government will now sit down and discuss their concerns with us,” Vautrey said.

“There are many practical and resource issues to be resolved, and the BMA is anxious that we start productive discussions as soon as possible.”

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