Choose your own adventure: The GP workforce crisis

Mark Steggles is a Sessional GP in Burnham and BMA sessional GPs committee member. He is on Twitter: @msteggy


Let’s explore solutions to the general practitioner (GP) shortage by means of a Bandersnatch1-esque choose your own adventure.


1. There is a shortage of GPs. Patients are struggling to get appointments. Do you;

a) complain that GPs are lazy & overpaid?
Go to 2

b) try to understand the causes?
Go to 3

2. You chose a) brand them as lazy and overpaid.

You’ve contributed to the demoralisation of an entire workforce who are working with unsafe workloads and unsustainable conditions. As a result you now have fewer GPs than you had before and access for patients worsens.

3. You chose b) try to understand the causes.

There is a shortage of GPs. Patients are struggling to get appointments. Do you…

You discover that there are fewer GPs with more patients than ever before. Their incomes have stagnated or reduced for over a decade. You learn GPs are working 10-14 hour days, burning out and despite working harder than ever they are vilified. Go to 4.

4. With this knowledge do you;

a) demand GPs work more, tell them they earn too much, impose a minimum 10 year period of NHS servitude, tell them to work more hours/days including weekends? Go to 5.

b) lobby your members of parliament (MPs) to improve conditions and funding for GPs so access might improve? Go to 6.

5. You chose a).

Unfortunately you’ve made the role of a GP even more unattractive and they are leaving or retiring at an accelerating pace. Patient access worsens and the knock-on effect threatens to overwhelm other already struggling parts of the NHS.

6. You chose b) lobby your MP and support your GPs.

Congratulations! Due to pressure on the government to improve GP working conditions safe working measures are implemented, they are provided with the resources needed to increase access and care and more doctors want to be GPs. More training places for GPs are provided, pension taxation rules that were preventing GPs from working more have been resolved and fewer GPs are leaving. You have more GPs, better access and safer care.


Editor’s notes

Choose your own adventure is a genre of book, television programme and computer game where the reader follows a different story based on choices at key moments. Popular examples from last century include the Fighting Fantasy series of books from Games Workshop, and the TV series by Russell T Davies, Dark Season. This was employed recently by the Black Mirror TV series with the interactive episode Bandersnatch. Readers no doubt will have encountered applications of the approach in medical education…

Featured image: Choose your own adventures – a selection, by Andrew Papanikitas 2022

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Euan Lawson says:

Thanks Mark! I was, back in my school days, a huge fan of the Fighting Fantasy series. The cover shown here of Deathtrap Dungeon – and indeed the one on the Wikipedia page, The Warlock of Firetop Mountain, brought the memories flooding back.

More seriously, your point is well made. My view is that those who push these messages – such as the Daily Fail, the Express, the Torygraph know this full well. (Most others just follow their lead and fall on GPs as part of an expression of fear and anxiety and frustration at diminished public services.) GPs and GP practices are a particular thorn in the side of the ideologues who would push open the NHS further to the marketplace – the decentralised network nature of practices makes it much harder to control and influence. (One underpinning reason for the batshit proposals by Javid to bring GPs under the control of local hospitals.)

So, in the end, a long game of eroding public trust in GPs is the only play they have. The worst thing is that it does work, at least to some extent, and we have to keep pushing back.

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