Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
Yes, its good! It’s a fast-moving portrayal of family practice as a dynamic, exciting environment. The family physicians in the film reflect a multicultural British society, and they look happy, enthusiastic and quite a cool bunch of people.
As Dr. Maureen Baker, Chair of the Royal College of General Practitioners (RCGP), tells us at the end of the film, the future looks bright after 10 years of tough times in family practice.
The problem, however, is recruitment. According to the RCGP, at least an extra 10 000 family physicians will be needed by 2020 — not only because of demographic changes in the population and an evolving workload, but because future Government investment in general practice means that more physicians will be needed to support increasing care in the community. The RCGP also points out that with up to 10 000 family doctors now 55 years of age and older, there may not be enough physicians to replace them, and there are already shortages in some areas. The gender balance in the film did strike me, however, as it included predominantly male doctors, and I wonder if they are trying to encourage more men to train as family practitioners.
Family medicine is also centre stage in the United States, where the Affordable Care Act, in spite of its difficult birth and infancy, appears to be having an impact. Primary care is centre stage. I was impressed when the first issue of the New England Journal of Medicine in 2015 introduced a series on international health care systems undertaken in collaboration with the Commonwealth Fund. The first article looks at health care in Sweden, where primary care is at the core. Even the Harvard Health Letter sounds a cheery note in a piece entitled “New year, new approach to health care,” which discusses patient-centered medical homes — so similar to the primary health care team. Everywhere, American medicine looks to develop primary care, but the United States has a shortage of family doctors because they cannot meet the numbers needed for expansion.
In the UK, family physicians’ earnings have dropped for the seventh year in a row, with family doctors much more likely than other physicians to say their workloads are unmanageable. According to the RCGP, family doctors in England have around 372 million patient consultations every year — an increase of 60 million since 2009/10. At the same time, funding for general practice has been falling year after year and is currently at a record low of just 8.3% of the overall National Health Service (NHS) budget. The NHS, and primary care in particular, has become a battle ground for the 2015 general election, with the different parties promising how they will bring primary care into line. Morale among GPs cannot have been helped by press stories suggesting that family physicians will soon be working seven days each week, or that they will be “named and shamed” for poor cancer referral rates.
Maureen Baker’s view of the future for family practice is optimistic, and I tend to agree. Family practice work–life balance and income are likely to improve, but the NHS and its future viability depend on a dynamic, energetic and enthusiastic workforce. If Zoe Norris’s piece in the Huffington Post on the reality of being a doctor in the frontline of the NHS wouldn’t encourage you to join the ranks of family physicians, watch the movie — see what you think.
Leave a Reply