Br J Gen Pract: Nature works: why don’t we? How living systems can inform the design of effective primary care


I have always found denial an excellent strategy. For years I had listened with
scepticism to reports of a crisis in UK general practice. In my surgery things were ticking
over reasonably well. Then in May 2015 I had a bit of a crisis of my own. In transition
to a new partnership structure I faced a few months of relentless on-call. I noticed myself
become less caring towards my patients, less diagnostically curious, and less assiduous
with my clinical records. My partners confronted the issue in a supportive way, the
staffing issues resolved, and I regained my equilibrium, and with it a keener sense that
all is far from well in UK primary care.


Doran et al’s paper in the BJGP gives a sobering account of why so many GPs
are getting the hell out of practice, citing impossible workloads, degradation of the
doctor–patient relationship, and negative media portrayals. These troubles are the cause and the effect of a recruitment crisis. A friend is a rural GP. With one partner down and a second due to retire, he simply cannot recruit. A dynamic training practice is on the brink of closure. In his patch, only three out of 15 GP training posts are filled. Now that is a crisis.

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Prof Trevor Thompson
GP, Wellspring Health Living Centre; Reader in
Healthcare Education; Head of Teaching and
National Teaching Fellow, Centre for Academic
Primary Care, School of Social and Community
Medicine, University of Bristol, Bristol.