A letter to the Prime Minister

Photo by mconnors at

Claire RobertsonClaire Robertson is a GP in Inverness.


Dear Mr. Cameron,

I have been meaning to write to you for some time, but, as I am sure you can imagine, life and work take over and the days fly by. The time has come over this last week having watched with interest the election results unfold and the Conservative majority see you remain our Prime Minister. Now that this second term is underway I plead with you listen to your dedicated public servants:

I am from a working class background. My grandfathers were a miner and a dairyman respectively. My parents, brought up well, went on to university and Art School in the 70s and became an art teacher and architect, both working in Moray for local authorities. I went to a good state school, did well academically and graduated in 2003 from The University of Aberdeen as a Bachelor of Medicine and Surgery. During my training, I spent time in Fairfield Medical Practice, Inverness in my fourth year and it was there, one Friday night driving home to see my mother, I knew my future lay in general practice.

I entered a GP Vocational Training Scheme in 2004 and trained in the same practice, becoming a fully fledged GP in 2007. I have worked full-time ever since in Fairfield Medical Practice, as GP partner since 2008. I work exceptionally hard, deal with difficult situations and many challenges. My admin time is in my own time. Our days are all about care balanced continuously with managing increasing demand. When I started as a partner we had 4000 patients but we now have over 6000. We are a small business. This increase in 2000 patients comes with little increase in funds in our Global Sum payment. Naturally we have increased staff, but GPs are what is needed and GPs are the most expensive commodity. We have to pay our reception and nursing staff, so we continue to manage our demand by working harder and harder. We have not increased GPs since I joined. Running costs increase year on year, as do salaries for our employed staff. We fight the daily media onslaught: greedy GPs, GPs care worse than ever etc, etc.

My care has never lessened, despite the increased demand from patients, health boards and Governments (revalidation, CQC etc). I try hard, so hard, every day to manage expectations and demand. It becomes the hardest part of my work. I cannot describe how hard, each day starting a fresh with the mantra to be an exceptional advocate for the patient, care, treat, diagnose, manage risk and expectations, provide value for money, use resources effectively and protect the NHS from inappropriate demands. By the end of the long day and in excess of greater than 120 patient contacts, the mind is sore and fit to burst at times. Treating the sick is the easy (if heartbreaking) part of the job. The service I provide is exceptional value for money. To be able to see a GP you know, who knows you and your family for 30 years of life hopefully. The benefits are well documented. Continuity of care (not access to a GP but your GP) reduces admissions, referrals and expectations. Those who see us, trust us, and the Health Service benefits in an un-measurable way.

The politicians, your party included, fuel the demand. Why do you need to see a GP every day of the week? You do not. Nor do you need routine referrals on a Saturday or late night Friday for the chronic condition you have had for years. Politics and media are fuelling unacceptable and unaffordable demand. The NHS is unaffordable as it is as you know but is a precious an envied service that we must never lose. I am trained to be a gatekeeper and effective manager of NHS resource and the desire to win votes pre election serves only to make my job harder. Yet, I make yours easier and save money for our country daily, weekly, minute by minute.

Your party in the last five years has made great attempts to begin long needed reform. The welfare reform, Universal Credit, is to be commended. Welfare and health reforms are never popular but we (the strong–shouldered) must stand strong. Reform is needed if we are to survive. However, politicians must be brave and honest. Of course, everyone would like to do everything 24/7 but I cannot do the things I wish to do when I finish late or start early, when shops and post offices are closed and accept I do not need to. General practice needs more resource certainly as do many areas of this 24/7 NHS you promise. I do not wish for patients to have to wait, but most can and should be told this. We can triage and manage illness demand safely. The rest are worried well. We must not pander to them, we must educate them.

You pledge 5000 more GPs. How is this going to be achieved? Daily the job becomes less attractive. At times even to me the job can seem unachievable constantly fighting the inefficiencies within secondary care and social care, having more and more work transferred to primary care without resources which takes up time to see patients, yet I try and try, harder and harder. Why? To make it work. To make the service better for all and for our future in this United Kingdom. Tiny drops in the ocean, but maybe, one day they will make a difference. The trouble is, it is hard to sustain this. GPs retire and leave to new pastures, as this level of work is not possible long term. How then can you recruit 5000 new GPs? The press and politicians slate us, not supporting us. Never saying to the public, actually your GPs provide an excellent service and you must use it more responsibly and learn to manage your own health. No, daily expectations are fuelled and demand increased, leading to dissatisfaction. The expectations are unrealistic and unaffordable.

We have a wonderful NHS. It can and should be more efficient and flourish but increased access to general practice is not the answer. Increased resource to general practice is needed urgently but you must allow us to manage our patients’ needs. (Our practice signed up to extended hours some years ago under the Labour government, funding has reduced and costs of opening increased, it is now just about affordable for us to continue with. Few patients attending work 8am-6pm, they just choose to come then as the appointments are seen as convenient.) I frequently offer people a number of appointment options during triage to be told “no I can’t come then or I don’t have transport, don’t worry I’ll just call NHS24 after 6pm and then I’ll get a free taxi up to A+E”. Our service is for medical need, not convenience and Governments should be brave enough to say this and deter the mis-users.

I respect our country, you Mr. Cameron and your Government. I thank you for keeping our country together last year. I thank you for my opportunities as a public servant and that of my partner, also with a similar upbringing to myself and attendee of the same school – a Royal Marine from the age of 16-27 and since in the Fire Service. We work very hard and are comfortable I admit but have the financial pressures of many and appreciate no Government suits everyone but we deserve respect and honesty. You have governed well and strongly and I hope that you can serve a second term honestly and sensibly as the country needs stability. I plead with you in this second term to save the NHS and our public services and the increased demands politicians fuel. It is unaffordable, unnecessary and will cripple us.

Good luck with this second term, but I plead with you please save our NHS in the right, brave way. Be brave and honest as our Prime Minister. Please tell people they can expect what they need but not what they want. If you find this plea unacceptable or the situation unbelievable I invite you to spend a day, seeing our demands as GPs to see for yourself and maybe then your party can truly understand what the country needs.

Yours faithfully

The British Journal of General Practice and BJGP Open are bringing research to clinical practice. BJGP Life is where we add the debate and opinion to help ensure everyone benefits from that research.


  1. The NHS in Scotland is devolved. As admirable as it is addressing David Cameron, his changes will have no effect here. It’s Holyrood you need to address, who will then more than likely ignore you, because they think they know better on everything.

    • This is a heart felt plea for someone to listen to the very people who face the frontline of demand, it has to be heard!

    • Her point is still very much valid. It’s the same situation in England.

      I do agree that the government (Holyrood or Westminster) need to start telling people that the NHS is not a convenience service. I know many people who won’t book a GP appointment and instead go to A&E for minor ailments (conjunctivitis, chest infections, etc) – these are not emergencies. We simply can’t keep putting the NHS under more strain by using it in this way.

      • I agree completely Janna, It is not a free service, it is paid for by the tax payers. There will never be enough money to keep everyone happy. People have to take more responsibility for themselves and also realise that just because something can be done doesn’t mean it should or needs to be done. Science advancement has gone beyond the amount of money that will ever be in the coffers of the treasury unless everyone is prepared to pay much more in tax.

    • I disagree. I think it is entirely appropriate to address this to DC. Much of this letter talks of the unrealistic promises made to the public and the negative comments made about our profession by the Westminster government. That, combined with the press, clearly affect the views and behaviours of the public in Scotland every bit as much as England.
      In addition, recruitment issues are massive and effect Scotland and England the same.
      Lastly, the budget that Hollywood gets is based on the Barnet formula and so closely tied to what England gets so devolution certainly does not protect us from changes south of the border.

      I accept that lobbying our msps will also be important but the nhs needs to be funded adequately and that is still in the hands of Westminster. As is the message we give to the public about the value of our nhs and expectations.

      • I disagree with the comment by Debby mcgregor that is, not the content of Claire’s letter. My post was entered as a response to Debby’s comment, not the letter as a whole but it does not seem to have been logged as such

  2. This Dr is right, I have seen it with my own eyes how tired they can become they are people to with families and homes. Their diction to their job. If our MP worked as hard as them we would all be better off. The His is what has made our country strong and dispite the demands on it we are lucky to have it. If Mr Cameron wants all these new doctors he better stop expecting them to pay £9,000 a year to train for 5 years.

  3. Beautifully, passionately written, Clare. Thank you for keeping the bright fire of General Practice glowing. May David Cameron actually read it. And may he then take your arguments to heart.

  4. The more the Government changes the NHS to ‘meet the needs’ of the patient, the more it costs and the more the demands of the patient outweigh their ‘needs’. Every Government term brings changes to the NHS (It’s the best tool the politicians have to win votes). Out of hours services put huge demands on the GP Profession – there are not enough GP’s in the system willing and able to work – there is not enough strength in Government and NHS Management to tell us ‘the patient’ that ‘yes, we acknowledge that you have a want for a 24/7 doctor but we will provide what you need’. There is not enough strength in Government and NHS Management to tell us, ‘the patient’ that our ‘needs’ will be met using the NHS as a whole – and not just your local GP. Invest and audit strongly – not just auditing by return of numbers – investigate and audit the NHS properly. Invest in the Pharmacists and Nursing Staff that hold the NHS together while supporting the GP’s in the heavy burden they carry. Allow our Nurses and Pharmacists time and give them the investment to increase their skills as they need. Invest and change the Education System to teach our children what the NHS is about and how it should be used. Teach them to have pride in our NHS and not to abuse it. Generations have gone by and the old ways of Mother, Granny, Chemist, Nurse then GP being the route for advice has passed – we can’t bring it back – so teach our children and improve the NHS for the future. I have worked with GP’s and the NHS for 12 years, seen difficult changes for all the professions and I wholeheartedly thank the professionals for continuing to provide these services. I have not had need, fortunately, to use them for myself but I’m grateful to them.

  5. I think that what is forgotten here is the amount of money that the GP earns, probably five times more than a teacher.

    • Mr Smith, GPs are paid fairly. You cannot compare what one profession earns over another. A GP has to train for 5-6 years at university with the associated debts that go along with it. Then it’s 5 years postgraduate training where they work long and unsociable hours (significant numbers of which are goodwill rather than paid) for little renumeration.
      It is then onto the Holy grail of GP land where yes some of them are paid reasonably well, but for which they can work 12 hour shifts, making potentially life changing decisions for their patients, drown in mountains of bureaucracy, meanwhile paying up to £30,000 in indemnity just incase a patient makes a complaint that their insurance company doesn’t want to defend against.
      Ultimately GPs need to be rewarded, otherwise who would willingly take on the job? I know I couldn’t.

  6. We must show high respect to our doctors, their dedication, care, hard work and sympathetic attitude. One thing we must not do is to compare them with other professionals and their earnings. Not to write much more than already written by many people before me. An ambulance is given way in the traffic so that a needy patient is taken as quickly as possible to the place where his/her life could be saved. Nothing is more valuable that life!
    J S Panpher

  7. This piece is hugely negated as it does not reflect how little the Tory government respect sick and disable people and their human rights. I find it strange how a working class doctor, working in a working class area can be so enamoured by the Tories. Especially as lots of pressures are being piled on GPS by the effects of austerity –

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Previous Story

A letter to the Health Secretary

Next Story

“I am sorry”: Burnout, bad day or normal general practice?

Latest from Opinion

Age Concerns

Arthur Kaufman reflects on intergenerational tensions from the older British citizen's perspective. It is easy to