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Crisis? What crisis?

Dr Jo Scott-Jones shares his thoughts on the workforce crisis, likening it to the perceived impossibility of the Chernobyl disaster.

Chernobyl, April 1986. The initial response to being told there was graphite from the central core of the nuclear reactor spread around the explosion site from the authorities was incredulity to the point of negligence. It was impossible, so it can't be happening. 

The reaction of the health sector to the consistent call since the 1990s initially from rural practices, then from Pinnacle, then from general practice as a whole, that there would be a workforce crisis by 2020 that would result in a significant disparity between the services that communities needed and the services that could be provided was similarly negligent.

Since then we have seen a fall in GP ownership rates from over 70 per cent to less than 40 per cent, a rise in GP vacancies in rural practices from around 20 per cent to 39 per cent and an increasing number of urban practices seeking GPs. 

Now :

  • more than half of all GPs are over 52 years old
  • 34 per cent of current GPs intend to retire in the next five years
  • 57 per cent of current GPs intend to retire within the next 10 years
  • short term contractors, and people working part time have become much more common.

There are more and more communities having to find alternatives to GP led services, often acutely when a long standing service suddenly falls over. 

Access has always been THE rural issue, it is rapidly becoming an urban issue too. 

"These men work in the dark. They see everything."

The initial response from the centre was "Crisis? What crisis?" Then accusations of patch protection, suggestions that role substitution was the only response, then stunned silence, and now finally we hear the current minister at the Rotorua GPCME conference saying, "We will try and fund as many GP registrars as you can find to seek training, but I can't promise anything." 

Well, hello, come on in and join the party, the rest of us are just about to leave.

We are seeing the impact of the lack of investment in primary care training for the past 20 years coming home to roost very rapidly, with more and more practices struggling to find staff, increasing reports of burnout as workload increases, practices pulling out of providing after hours care, and pressure building on GP provided palliative care services. 

The practical impact of the Minister's promise to fund more GP trainees, if we can find them, is like the first drop of boron sand on the Chernobyl reactor fire.

"The real danger is that if we hear enough lies, then we no longer recognise the truth at all"

The sad thing is that unless the job of being a GP is perceived as both valuable, and rewarding we won't find the doctors who are willing to train to fill the spaces. In the meantime, we will lose some of the core roles that provide the stories of job satisfaction that we all share over the barbecue. 

We talk about the patients who we rescued from emergencies, the patients we served in their final days, the families we supported through a crisis, and for some of us that are old enough the babies we delivered. 

We also talk about the teams we work in, the connections we make with people, the privilege of being allowed into intimate moments, the pleasure of solving complex diagnostic problems. 

Having influence at a national level has been part of Pinnacle's response to the workforce crisis that was recognised in the late 1990s. It hasn't got us anywhere very fast but, for example, we continue to advocate for appropriate funding for primary care, for a recognition that while 98 per cent of health care happens in the community, it is crazy that only 2 per cent of funding ends up in the community. 

But Pinnacle didn't just ask others to provide solutions, Pinnacle GPs developed the Health Care Home model of care that is now extending around the country. This is not a "one size fits all" solution, but a process for adaption to new circumstances. Yes, there are proven structures that help, but how they work varies from practice to practice according to need. 

Practices recognising they have to change in response to the increasing demands and reducing workforce availability have options and support to make change. New ways to deal with acute demand, to improve proactive care, to make work more effective and efficient can be found. 

Working in Health Care Home practices around our network I find myself never overbooked, always having time to complete tasks during the working day, and seeing patients who need to be seen. There will always be hard to reach patients with complex care needs, there will always be stress in this job we love, but there is hope that we can improve the value it brings to the communities we serve, and the rewards we reap. 

We can't put out the fire on our own, but we can make the places we work in more attractive and in the process create an environment where we and our teams will survive the crisis. 

What crisis? 

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