In defence of GPs

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.

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