In defence of GPs

Charlotte Jones responds to recent comments on the future of GPs and technology

In a recent article published in the Western Mail it was stated that “we don’t need GPs” and that “GPs are obsolete”, with a further suggestion that GPs should be replaced by robots. When I first read what had been written, I felt sure that it was an April Fool’s joke but sadly checking the date showed it was a very real article.

The article states that 50% of the Welsh budget is spent on health and “the way things are going, if you remain with producer capture it’s going to be 60%”. It is true that around half of the welsh budget is spent on health, however funding for general practice is actually currently at 7.6% (from a high of over 10% in 2004 and a clear expectation with the introduction of the new contract that the % figure spent on general practice would rise further). That GPs are able to provide high quality patient care despite a significant drop in funding is remarkable and should be lauded. Despite the claims of “producer capture” general practice needs to be funded correctly so that high quality sustainable care, by high quality GPs and their excellent teams can continue for many years to come.  

I provided an initial comment to the Western Mail when the article was first published, noting how GPs are the backbone of the NHS and are still considered to be very much part of the community throughout Wales. I’ve been a partner at a GP practice for over fifteen years and chair of the BMA’s Welsh General Practitioners Committee for four and I can say with utmost certainty that patients want, and need, their GPs who provide a wide range of services for acute problems, continuity of care for chronic problems and are independent patient advocates meeting their patients needs from cradle to grave. GP teams provide in excess of 23 million patient contacts per year and have a myriad of other tasks they are responsible for. Yes, technology has a role in supporting primary care and Welsh GP IT is streets ahead of many other parts of the UK, but the idea of replacing GPs in their entirety with computers is a ridiculous suggestion; a view that has been shared over the past few days by our Cabinet Secretary for Health and Social Services, the RCGP and GPs across the length and breadth of the country.

Being a GP involves not just diagnosing and treating patients but also involves considering the holistic needs of a patient and their loved ones which often includes offering emotional support and a clear understanding of the complexities patients present with. This level of humanity, which is so important, particularly to vulnerable patients, cannot be replicated by a computer.

As a means of evidence of the value of GPs, if this is even needed, 90% of patient contacts with the health service in Wales is via GPs and this contact is valued immensely by patients. It was noted in Healthcare Inspectorate Wales’ most recent annual report that “patients reported high levels of satisfaction with the care they were receiving from the GP practice teams.”

The comments made were offered as a solution to the question ‘Why is Wales’ economic development behind that of the rest of the UK?’ Scrapping the very best elements of our healthcare system would indeed save money but at what other cost?

So let’s now dismiss this obscene notion that GPs can be replaced and focus on the real issue; saving general practice.

As with any backbone, if you apply too much pressure it will break – and it is widely accepted that GPs are under immense pressure. That is why the Welsh Government introduced its Train Work Live campaign to help alleviate some of the pressure GPs are under. I’ve welcomed the scheme – as a small piece of a big jigsaw – but we need more momentum on training and attracting new GPs and practice nurses to Wales as well as clear robust plans to retain our current workforce.

In addition, practices and individual GPs are struggling with the workload pressures which are ever increasing, unrelenting and increasingly complex.  

In Wales, we have an ageing population, many of whom have more than one condition that needs to be treated, so there is a need for patients to be treated and diagnosed now, more than ever, by a doctor who can look at their holistic needs; and not a computer programme. I reiterate that technology plays a role in medicine, there is no doubt about that, and it is invaluable to us as modern clinicians – but that role is in support of GPs and their teams – not in place of them.

It is worth remembering that there is no “average” day for GPs. Each patient is different. Each case is different. A patient-centered, holistic approach is always needed to treat the patient as a whole and whilst a computer may be used to treat a patient’s presenting condition, on its own it may miss underlying, more serious conditions that require attention. That’s what GPs are trained to do – treat patients as a whole, whilst employing a level of empathy, and GPs do this well.  

Replacing GPs with computer programmes would remove the humanity from healthcare – and everyone deserves to be treated with humanity.

All articles published on Click on Wales are subject to IWA’s disclaimer.


Dr Charlotte Jones is a GP in Swansea and chair of the BMA’s Welsh General Practitioners Committee.

11 thoughts on “In defence of GPs

  1. I agree that entire replacement of GP’s by technology is not going to happen any time soon. In fact, there are very few jobs that are entirely replaced by technology [factory robots are the exception, taxi driving might be next] – But what does happen is that increasingly large parts of a single job role are replaced by technology. And if it is welcomed, that is to be applauded, because it opens up time to concentrate on the valuable point you make – That the humanity of GP’s is key to Primary Care.

    There is, in my view, a way forward here – But it requires the Medical world adapt to the explosion of technology opportunity in patient care – But that means that the job of being a GP will change increasingly quickly over the next few years – And I assume that your member will enthusiastically embrace that change.

  2. When | go and see my doc – not frequently as it happens and fortunately – I notice he listens to the symptoms and starts typing on his desktop. The he has a read and he examines me and types some more on his desktop before offering a diagnosis and either a prescription or a referral. Could he be using some computerised diagnostic program to help him? I’ve never liked to ask. I’m with Mr DavidJones; I don’t want to get rid of my old doc but there seems to be a place for technology. And I think Dr Charlotte Jones has been watching Dr Finlay’s Casebook (someone else explain to younger readers). My doc is harassed, as she says, but that means he has ten minutes for me, including the sympathetic smile. Then he’s on to the next patient. If I have *holistic needs* he’s got no time wonder what they are or ask about them.

  3. If the GP system works so well why is it that any time you go to an A&E department in Wales, day or night, it is packed out by people who mostly have not had an accident?. If you sprain an ankle or develop alarming symptoms outside surgery hours the GP won’t help you. It’s a locum or the A&E for you. If you take to your bed you are encouraged to get up and somehow get to the surgery because home visits by the friendly family doctor are a thing of the past in many, if not most, areas. It is fair enough for Dr Jones to protect her professional interests but spare us the romanticism.
    No one suggested that GPs should be replaced by robots. What was floated was replacing them with experienced nurses using online diagnostic aids and with a hotline to a doctor or specialist. The “robot” remains in the service of medical professionals. Might the time of our trained doctors go further and be more efficiently used that way?
    If informed medical opinion says not, I must bow to their superior knowledge. But then the question remains, what measures can stop the health service swallowing more and more of the Welsh government’s budget? General Practice is a very small part of that but at 7.6 per cent, it costs over £550 million a year. A 10 per cent efficiency gain would pay for over a thousand teachers.

  4. I’m disappointed that Professor Holtham is continuing to ignore the value of General Practice. It is plain wrong of him to say that GPs won’t help a person outside of their surgery – in fact I recently did just that and had a lovely thank you letter from the patient. This shows the public value the hard work of GPs, even if Professor Holtham seemingly does not. There is a myriad of reasons why people attend A&E – it is too simplistic to imply it is because GPs aren’t doing their job. Some go because it is more convenient for them, some because they want a second opinion and consider the A&E departments as more specialist care and yes some do go there inappropriately because they can’t get a GP appointment (our service like others are under enormous stress and pressure and is creaking at the seams). Lots of research into A&E departments confirms the above.

    There’s no romanticism in my article – I work in General Practice at the coal face both in the daytime and at weekends. Pressure is at its highest whilst morale is at its lowest, and frankly, suggestions and comments like these do nothing to improve morale.

    I’m extremely disappointed that Professor Holtham hasn’t mentioned other areas of the public sector where efficiencies could potentially be made. As I said in my article GP teams have 23 million patient contacts per year, yet we receive a set amount of around £149 per patient per year. I would argue that General Practice is one of the most efficient parts of the public sector, the lack of funding has meant we’ve had to be and GP practices are working as lean as they can and there is no potential for further “efficiency savings” without there being a consequential negative effect on the GP services offered to patients – services people value. I am pleased that Professor Holtham has responded directly to my article, however, I note that there has still not been a response to Dr Rebecca Payne of RCGP Wales’ offer of a debate. I strongly encourage you, Professor Holtham, to take Dr Payne up on her offer.

  5. Dr Jones, I have replied to Dr Payne. My point is not to criticise GPS who I am sure are hard working and conscientious. It is to question whether the current system is the best use of scarce medical resources and the best gateway to the NHS. Moreover as I said to Dr Payne and to you if the experts say I am barking up the wrong tree I must accept that. I do not pose as a medical expert. I was challenging not prescribing. Of course there are inefficiencies across the public sector but it is the health service where demand and current practice threaten to take an ever rising share of public spending. You and Dr Payne are in a better position than I shall ever be to say where greater efficiencies can be found. I don’t
    pretend to your knowledge and the public spending crisis is undeniable so I not sure what we would debate.

  6. If the GP system works so well why is it that any time you go to an A&E department in Wales, day or night, it is packed out by people who mostly have not had an accident? If you sprain an ankle or develop alarming symptoms outside surgery hours the GP won’t help you.

    Professor Holtham,

    Firstly, A&Es are funded by activity. The specifics of which differ according to local agreements, but essentially, the more patients they see, the more the Trust gets and that then filters down to the A&E department. It is not in their interests to turn away non-accident and emergency work as this is the easiest money to earn from their perspective. Often, and again this is dependant on local agreements, the Trust will earn as much, if not more, for one patient presentation at A&E that a GP will be paid for looking after that same patient for the whole year. Hence, you will see A&E department with non-A&E patients in them because it earns them money and turning the patients away does not.

    Secondly, The King’s Fund looked into this and found no significant correlation between A&E activity and GP availability. Likewise, it found no evidence to support the claim that changes in GP contract 2004 resulted in increased A&E activity.

    With the very greatest of respect, your research into the subject before making public your thoughts has been below the standard that one would expect from a Professor.

  7. Of course we should not try to replace GPs – but we could use them better and supplement their services by using other health care professionals. For example we should make better use of telephone consultations (many consultations are a simple matter of repeat prescriptions etc). There is plenty of research to show that advanced practice nurses can do much of the work that GPs now do (of course I know that there is a shortage of nurses too). GPs are suffering from a general perception that they will do nothing unless they get paid more – this does them no favours. The business model of independent contractor status does them no favours either.It is a tragedy that the 1973 reorganisation of the NHS which was meant to integrate the tri-partite service managed only to achieve a bi-partite service – because the gps stayed outside. Forty years ago I was part of the huge activity supported by the RCGP and the RCN to develop primary health care teams -I’m not sure that we have progressed much since
    june clark

  8. Dr Cat, if you check you will see I made no assertion about why A&E departments are full. I asked a question. I take your point about the way A&Es operate. Several doctors have reacted vigorously to someone raising questions about the organisation of health services. But the questions are prompted not by some odd anti-doctor malice but by a crisis in public finance and the ever rising share of the health services. I notice that while my speculations are dismissed and I am being put in my place none of the medics has acknowledged the public finance problem or offered any counter-suggestions of their own for improving efficiency. As I keep repeating: tell me that my thoughts are misguided and I accept it. But then acknowledge money doesn’t grow on trees and tell me what we should do about it.

  9. Professor Holtham,

    If the GP system works so well why is it that any time you go to an A&E department in Wales, day or night, it is packed out by people who mostly have not had an accident?

    It’s quite clear that you linked A&Es problems with how well the GP system works. You’re not walking away from that one.

    I notice that while my speculations are dismissed and I am being put in my place none of the medics has acknowledged the public finance problem or offered any counter-suggestions of their own for improving efficiency.

    The OECD has already ranked the NHS the most efficient.

    The reality is that further cuts are going to impact clinical services even more than the current “efficiency savings” i.e. cuts. Waiting lists are getting longer, community hospitals are full of patients awaiting social care because social budgets have been cut down to the marrow. Ambulance waits are getting longer, and hospitals no longer offer patients post-discharge review appointments but tell them to see their GP instead.

    But here’s the deal. Fast, cheap, good. You get to pick two. And when you do, you get to be responsible for the outcomes. So when the cuts result in increased mortality (and they will), you get to stand in the dock, not the medic trying to do their job with one hand behind their back.

  10. Professor Holtham,
    Perhaps the focus should be on (1) inefficiencies of service provision eg duplication of services, fragmented service provision, inadequate social service provision (which inevitably affects healthcare contact and wellbeing) and why services aren’t moved into primary care when the prudent health care argument is clear along with this enabling care closer to the patient’s home
    (2) costs of using locum staff to fill vacancies across healthcare – the issue here is about whether there are effective workforce strategies deployed in advertising jobs that will appeal to individuals and thus enable sustainable services
    (3) review of management costs across NHS Wales – have been told that these have increased significantly over last few years and my question to you would be is that investment the right use of scarce resources?
    If you want more information on just how efficient GP teams are then please do contact Carla Murphy at BMA cymru who will be happy to send your our GPC Wales strategy document which is an evidence based report into problems and solutions that if addressed would lead to sustainable General Practice for Wales (and it does reference technology and working wirh colleagues but not in the way you have suggested)

  11. Dr Jones provides places to look for improved efficiency which is constructive. I certainly accept that inadequate social services inflict further, and probably disproportionate costs on the health service and I have proposed a solution on this website involving higher national insurance payments. Management costs are a conundrum. When management isn’t working the solution always seems to be more management so it is very credible that an audit of management itself would be useful.
    Personally I find Dr Cat’s post less constructive since it’s a simple demand for more money. There is room for some increase in taxes but there is a limit to how far the electorate will allow politicians to go down that route. And the diversion of resources from other public services is surely near its limit, at least in Wales.

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