Yesterday I was flipping through a medical journal and read something that brought back the past very vividly. It was an account of how a young GP, who was a mother of school age children, was struck off the medical register for 5 months, because she had been dishonest in saying that she was already working (and therefore could not be given any more work) when in fact she had to leave in order to pick up her children from school, at 6 pm. It appeared that she had put in the appointments book two fictional patients and given fictitious details, at the end of her surgery, because her sessions often overran, and she had been unable to find some-one else to do the pick-up.
It took me back to the early eighties when I was in that situation fairly frequently, finding myself still seeing patients an hour after I was supposed to finish, and needing to find someone to pick the kids up. It is every parents nightmare, At that time I usually called upon my long suffering parents, who would always come. But when the children were ill, not very often fortunately, and I had to call in to be excused a booked surgery, I felt I couldn’t tell my partners the real reason, because my male partners, who always had a wife or some other female to look after the children would tut-tut and not be sympathetic at all. Once my excuse was that my car wouldn’t start and I had to take it to the garage. They would always understand that because it was a rural practice and transport was crucial – and they had found themselves in that situation. It showed how difficult it was in those days to be a female GP with children. Things are so much better now in that regard.

However I wouldn’t say that conditions for young GPs in general have improved over the years. Far from it. Yes, we had to do on-calls regularly at night (and go out to actually see patients in their own homes!) and still work the next day, and we certainly didn’t get paid much in the early days. But we didn’t have any student debt to repay, and I felt well enough remunerated to buy a small house myself in the year after joining the practice. Now, as I have said before, junior, now called “resident”, doctors both in hospital and in general practice have seen their pay slashed since 2008. Doctors who have qualified recently find that they cannot afford the lifestyle that they expected to have and are struggling. Well, you might say, this applies to many young professionals, who think they are hard done by compared to their parents. But doctors in training are the lifeblood of our health system; they do all the day to day work (supervised by their seniors), and we need to keep them. But the system of training doctors has remained the same for decades. Once qualified, you have to apply for and get a series of jobs in different specialities, sometimes in the same speciality if you are sure what career you want, or to try ones out if you don’t know. In my day there was always competition for the best jobs, but there was no problem getting some sort of job. But now, I read that there is an extreme shortage of jobs in most specialities, and so you cannot be sure you will get a job at all, with all the pressures on finances and your professional development that that entails. In order to make sure that doctors expensively trained in the NHS get jobs, they now get preference over doctors trained overseas. This is obviously sensible and all countries prioritise their own, but this means that fewer overseas doctors are applying, The NHS has always depended on them coming, and for their part they see the training they get here far superior to that anywhere else, but we can ill afford to reduce the numbers coming in. The answer of course is to make sure there are enough jobs for everyone who wants to work here (and many overseas doctors do not and go home), for the future of the service. But at the moment hospitals are cutting the jobs because they can’t pay them in the present straitened circumstances. So we have a double whammy – young doctors see better jobs advertised in Australia and Canada and other places and go abroad, and young doctors in Europe and all over the world are reluctant to come. Apparently there is now such an increase in casual racism in the NHS that doctors of colour are thinking twice about coming. If we can’t get enough resident doctors then patients won’t get treated. I think we have a very dangerous situation developing. It is a reason why doctors are promising to go on holding strikes. They see the pathways to becoming a reasonably paid professional in this country disappearing and some are becoming desperate.

So back to this lady who has been suspended for 5 months because she “fiddled” the rota in order to ensure she could pick up her kids from school. This means that she will lose pay for 5 months, and the practice will have to find someone else to do the job for just 5 months.They are short staffed as it is. She did apologise profusely and say that she would never do anything like it again; the practice supported her and wanted her back. But the panel on the GMC were adamant that nothing short of full suspension for 5 months would do to protect patients. Really? would not a fine and a telling off do?
The GMC has always policed doctors’ behaviour very vigorously and most doctors in my day were terrified of complaints and the possibility of referral to the GMC’s “fitness to practice” committee. It doesn’t seem to have changed much, and is completely out of touch with the realities facing doctors now. It is yet another pressure on young doctors,. Real fraud, bad behaviour and dishonesty should be called out, but the punishments really should be more appropriate, in my view.

References

1.https://news.doctors.net.uk/news/5Egp918msjzkofTRMQYEE7#forumDiscussionArea

2. https://scepticalgp.com/2024/01/03/can-the-nhs-survive/comment-page-1/#comment-184

However a Financial Times analysis of occupational pay over the last 10 years indicates that doctors’ pay have performed worst of all. This was compiled in 2024 and as a result of strikes, doctors’ pay has increased further.

Gross annual pay rebased 100 = 2011
Train drivers 140
All workers 132
Fire service. 121

Nurses 105
Higher education teaching 104
Medical practitioners 86