Mojo matters

"Bugger!” was my immediate response when reporter Fiona Cassie shared the figures from the latest Medical Council workforce report. A net tally of only 15 GPs added to the workforce in the last year. And then the news that numbers signing up as GP registrars have declined for the coming intake.

Besides the impact of the declining numbers on your general practices, there is the kick in the guts that comes with feeling the profession you have devoted a good portion of your career to, does not rate among the next generation of doctors.

You live in a downward-spiralling Catch-22.

It is a challenge to talk up general practice when the sector is exhausted, swamped with work, and still battling for pay parity for nurses and a review of the primary care funding formula.

While we have seen far more GP faces fronting up in the news media in the past couple of years, they are often delivering bleak news.

Admittedly, some of the news has been good: the Government has put money into GP training, higher pay rates for GP registrars and increasing medical student exposure to general practice. But it’s too early to see the effect this might have.

We know most GPs love general practice. Every fortnight in our “A few words” column, you tell us you love your work, your teams and your patients.

What you don't love are the cost burdens arising from the out-of-touch capitation formula married with fees restrictions, and what the failure to address these problems says about the regard with which the profession is held.

Attitudes to money hamper the sector. GPs are far too coy with regard to the return a well-run (and properly funded) practice will give to its practice partners. Because that’s another Catch-22 – talk about the profitability of general practice and you feed into the bias of health bureaucrats and politicians who see GPs and other primary care providers, as private-sector schemers looking to get as much money out of the public purse as possible.

These folk would rather pour more money into hospital emergency departments and outpatient clinics than fund primary care to do a better job for patients and the system as a whole.

But not talking about the profitability of general practice means medical students go looking for a secure financial future elsewhere and the downward spiral continues.

And the cost will land with the taxpayer.

When it comes down to it, the GP specialty needs to find its mojo.

General practice needs to capture some of the “cool dude” factor that has rural hospital medics walking tall, to bring the punters back from emergency medicine and urgent care. Because cool matters, and why not, to astute young people making decisions about their future.

By now you might well be asking yourself, can general practice be the Skoda of the medical world? (Maybe you aren’t, but it is a good question.)

Skoda, a luxury car brand in the 1920s, ended up a laughing stock when it came under state ownership in Communist-Bloc Czechoslovakia after World War II. By the time Volkswagen took part ownership in 1991, Skoda had a reputation for rattling and breaking down, and a red paint job that quickly faded to pink. It was the butt of jokes.

• How do you double the value of a Skoda? Add fuel.
• What do you call a Skoda driver with a speeding ticket? A dreamer.
• Why do Skodas have heated rear windscreens? To keep your hands warm while you’re pushing it.

When the Iron Curtain fell, Volkswagen took full ownership and invested in new design and tech, and ran a clever, self-deprecating advertising campaign. Then Skoda, long derided, became cool. At least, that is the marketing myth.

General practice doesn’t need myths, it has its reality of great work stories and ever-changing challenges. Pity the medical specialists dealing with bits of the body and not the whole, left to wonder as unfinished patient stories walk out their door. But, as the funding crisis drags on, and the pool of enthusiastic next-generation GPs dries up, the great work stories are losing their shine.

The answer doesn’t lie in pulling down other medical specialties – it lies in elevating the general practice specialty, urgently.