colleagues was visiting an elderly patient to give him a check-over and to reassure his wife. He had already mentioned that he would have a listen to his chest but then found that he had left his stethoscope at the surgery. Not wanting to admit this, he instead took out a 2p coin from his pocket and carefully placed it at various points on the patient’s back. He was using the coin to mimic the bell of his stethoscope and as the patient was facing the other way, he imagined he would be none the wiser. Apparently, the patient seemed happy enough but just as my colleague was on his way out he stopped him: ‘Just one thing, Doctor. I’ve seen some things in my time but I’ve never seen a doctor listen to my chest with a 2p coin.’ The doctor hadn’t noticed the mirror on the dresser that enabled the patient to watch him examining him. My colleague came clean and apparently they had a bit of a laugh about it. Just a lesson for us all not to ever try to pull the wool over our patients’ eyes!
Sex
An astounding part of being a doctor is that a complete stranger can walk into my consulting room and within two minutes I can be asking them about their deepest, darkest sexual habits. A full sexual history is vital for accurately diagnosing and treating many illnesses. It is also a great way to find out exactly what people get up to behind closed doors! I am still amazed by my patients’ sexual escapades and also about how honest, open and unembarrassed they are when telling me all about them. My patients make me feel very boring as they recall tales of dogging, rimming, fisting and various other sexual behaviours that I have to Google in order to know what they are talking about.
The youth in my area seem to be amazingly promiscuous and I was astonished when I met a patient who had kept her virginity until she got married at 23 years old. Her husband had apparently done the same and they had been using condoms for a couple of years until the previous month when they had decided to start trying for a baby. Jane, the woman in question, came to see me complaining of a creamy white vaginal discharge that she was now getting after sex. I feared the worst. I was sure her husband must have been having an affair and that she had caught some kind of sexually transmitted infection. I ordered a full set of vaginal swabs but everything came back as normal. It was only when she returned to see me and I asked her to explain her discharge symptoms in a little more detail that I realised that the post-coital discharge she was describing was actually just her husband’s semen.
Money
Do GPs earn too much? That has certainly been the general consensus of the media over the last few years. I personally don’t know any GPs who earn ?250K as reported by the press; however, most GP partners who work full time earn over ?100K, which seems a lot of money to me. I am not a partner myself but do fairly well out of being a locum GP and just a few years ago I was working considerably more hours as a hospital doctor for less than half the money.
The reason GPs earn so much is mainly political. I appreciate that many of you will be fairly uninterested in this and have brought the book to hear some amusing stories about patients coming in with unusual objects stuck up their bum, etc. If this is you, please skip to the next chapter.
• We are highly trained — on average, it takes about 10–12 years to become a GP from starting medical school.
• We have a stressful and difficult job.
• We work hard. Most GPs work long days with lots of evening meetings and commitments.
• We have a high tendency to be sued and pay ?5,000 per year on our defence union fees.
• We are generally very popular with our patients, with 9 out of 10 of you stating that you were very happy with the services provided by your local GP practice.
• We provide a very efficient service. It has been quoted that it costs the British taxpayer about ?20–25 for a visit to a GP. The value of this is very evident when compared to a visit to an A&E department, which costs ?75 per attendance and one visit to a walk-in centre costs ?37. Amazingly, one visit to an out-patient department costs around ?150.
• The time spent per consultation with your GP has trebled since the NHS was created.
• We earn peanuts compared to premiership footballers!
• Our training is long but not as long as the training for hospital doctors, yet we tend to have higher earnings than most hospital consultants.
• We do work hard but most GPs no longer have to see patients during weekends and nights, unlike most of our hospital colleagues.
• We perform a vital role but so do hospital doctors, nurses, teachers, social workers and most of the public sector. Our pay is disproportionately higher.
We are only earning lots because we are reaching the targets the government sets us. The current GP contract was made by the Labour government, who foolishly didn’t think we would achieve these targets. GP partners are generally bright, motivated people and when they realised that they could earn considerably more money by jumping through some hoops they quickly learnt to jump and became very good at it.
I’ve talked a bit about targets before. They are called Quality and Outcomes Framework (QOF) points and basically involve us fulfilling certain criteria with certain patients. For example, if I have a patient who has had a stroke, the practice earns points if his blood pressure is regularly checked and is well controlled. There are targets such as this for patients with asthma, diabetes, mental health problems, epilepsy and many more chronic conditions. Within a couple of years most surgeries worked out that they can actually reach these targets and make a lot of money. Technology has helped a lot and we now all have systems installed on our computers that flag up all our patients who need tests to reach our targets.
For example, every time a patient who has had a stroke walks in, the computer will flash up that his blood pressure is too high and will carry on nagging me until I have entered his reading on the computer. If the blood pressure is above a certain target level, it will nag me until I have given him enough blood pressure drugs for the target to have been reached. This is why sometimes you might come to see your doctor to grab some lotion for your child’s head lice and the GP will check your blood pressure, ask if you smoke and get you to fill in a questionnaire about your mood. Your GP might not particularly care about any of these things and neither may you, but if we record this information on the computer, then we earn more points and more money.
It doesn’t take long to do a blood pressure check or ask about smoking, but to reach some of the targets requires quite a lot of work. For example, if you are diabetic, there is a long, time-consuming list of data that needs to be input on the computer. This sort of information can’t be quickly gathered in a normal consultation when you pitch up for something else. GP partners have realised this and much of the tedious data collection is best done by practice nurses. Paid considerably less than us, they do a lot of the work and basically earn the GPs their big salaries.
So if GPs are reaching all these targets and are earning all this money, why on earth did the government agree to the current GP contract? The main reason was that morale among GPs was at a particular low a few years ago. This was mostly because they were working long antisocial hours in difficult conditions without much reward. Lots of GPs were ready to retire early or move abroad and in some areas it was becoming impossible to fill GP posts. If it takes over ten years to train a GP, a shortfall could have led to a real crisis. A dearth of GPs would have meant patients waiting even longer for an appointment. Healthcare can be an election breaker and I think Labour probably felt that unless they did something to encourage GPs to stay in the profession, they could have lost the general election in 2005. The increased salary, together with the removal of an expectation that GPs would work evenings and weekends, prevented the early retirement of many very good GPs. It has also encouraged a large number of excellent young doctors to move into general practice when previously they might have chosen to stay in
