Jumping through hoops

We are definitely underfunded in GP land. And we have all become pretty blase about jumping through hoops set by the government in order to get more money. But this is not necessarily a good thing. And here’s why.

First of all you need to understand how general practice is funded in the UK. We get a basic amount per patient on our books. This is weighted, so GPs in geopgraphically more challenged areas will earn more per patient than others. And that seems pretty fair, right?

But the main bulk of our funding comes from the additional work that we do. In short, we are given a whole bunch of hoops to jump through, and the more we jump, the more money we make. Many of these hoops are without doubt in the best interest of our patients. Patients with epilepsy and schizophrenia should definitely be getting a review every year. Diabetics need to have an annual foot check. Patients with complex chronic conditions such as asthma need to have an annual medication review.

All this goes without saying. But some of these hoops are arbitrary. Others are actually damaging our patients. I would argue that keeping an “ob*sity register”, weighing patients annually, and referring them to weight loss problems falls in to the latter.

But we’ve become so accustomed to jumping that we never stop to ask ourselves whether this is in the best interest of our patients. Because at the end of the day, profit will always come before people. And in a profession that has been taking a living wage cut every year for the last 12 years, that is especially true.

I don’t think GPs are bad people, on the whole.

But I do think many of them have implicit anti-fat bias. In fact, I would estimate 75% percent of them if this study on medical students is anything to go buy. I also think that the majority of GPs are extremely privileged. Some of them may belong to marginalized groups, but most of them will still be privileged on the whole. And privileged people are often blind to the challenges faced by the oppressed.

So that’s three reasons why I am challenging my GP colleagues to do better. Firstly, they’re too used to putting profit over patients. Secondly, they’re biased. And thirdly, they’re coming from a place of deep privilege. So even if this doctor was right and jumping through hoops did lead to extra funding, how on earth can we trust GPs to use this funding to help us?

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