Wednesday, February 3, 1999 Published at 15:50 GMT
GPs threaten mass resignation
GPs feel they are under increasing pressure
GPs are threatening to resign en masse because of overwork, patients' unrealistic expectations and a fall in recruitment.
Half of Portsmouth's GPs have written to the government warning that doctors are so overworked that some are taking to drink and drugs.
Several others have had to retire after suffering nervous breakdowns.
The doctors said they would resign if nothing was done to improve their conditions.
In the 20-page letter, 50 of the city's 107 GPs say: "Doctors in general, and GPs in particular, are thoroughly demoralised and most wish to leave the profession as soon as possible.
"Many think it is now time to resign en masse."
The letter has been sent to government officials, including Health Secretary Frank Dobson, and an all-party parliamentary group looking into doctors' morale.
It calls for a full and open review of how NHS funds are spent.
It says growing pressures have contributed to the deaths from alcoholism of two of the area's GPs. Other doctors have had to retire because of alcoholism.
The GPs complain that they are being given too many new responsibilities, which is increasing their workload massively.
"They abuse [doctors] have suffered over the past 10 years or so is such that most will not tolerate it for any longer than they have to," says the letter.
They add that their salary has not risen in line with other similar professions and that they would need a 50% pay rise to catch up.
Dr Lester Russell, whose practice coordinated the letter, said GPs could end up like dentists, with some people not being able to access primary care because of the shortage of doctors.
Each GP in his practice has 2,500 patients and they do not want the number to go up any more.
"It is pretty dire," he said. "But people think GPs are out playing golf all the time. It will only hit home when people start finding it difficult to register with a doctor."
He added that his practice had had four trainees in the last four years. None had been from the UK and they had all returned to their own country after being trained.
One problem facing doctors was increased public expecations which had made GPs more defensive, he said.
This meant doctors were more likely to order unnecessary and costly investigations just to cover their backs.
His practice's legal bills had soared from £540 in 1990 to £2,000 in 1998.
"Defensive medicine is expensive medicine," said Dr Russell.
Dr Hillary Bagshaw, another of the signatories to the letter, said: "We need 50% of medical students to enter general practice, but only 18% are now doing so. The reason is the lives we are leading," he said.
Another problem is increased workload and the prospect of GPs being saddled with yet more paperwork when primary care groups are introduced in April.
Dr Bagshaw said many doctors believed the government wanted primary care groups to fail so they could introduce a two-tier medical system similar to the dental system.
"It will be put down to GPs if primary care groups fail. It will be said that we did not make them work."
"But there are fewer GPs per head of population in the UK than in most other developed countries and we spend less of our GDP than most others.
"It is time people woke up and realised that they cannot expect a Rolls Royce or even a BMW service with the resources we have. What we have is a knackered Ford Fiesta."
Dr Bagshaw normally works a 12-hour day and regularly has nothing to eat while he is at work.
"Our lives are no longer tolerable," he said. "Many doctors come home and grab a bottle of alcohol."
The British Medical Association said the letter echoed what they have been saying for months about pressures on GPs and the crisis in GP recruitment.
Doctors are also worried at the impact NHS reforms will have on their workload, particularly the introduction of primary care groups.
A recent study also showed that government guidelines to GPs had increased massively in the last few years.
In 1990, eight guidelines were sent out, compared with 138 in 1996.