Fighting for the Soul of General Practice e-bog

This collection of stories from two practising GPs describes the reality of working within a failing and highly bureaucratic system, where there is a balancing act: regulation versus relationships; autonomy versus standard practice; algorithm versus individual attention.We aren't suggesting a return to a 'better' time. We don't object to being bureaucrats, embedded within and accountable to the systems we are in. But we do want to consider how and with what the gap left by the old-fashioned GP has been filled. We use stories based on our experience to describe the effect of different facets of bureaucracy on our ability to maintain a nuanced, individualised approach to each patient and encounter; and to question the prominence and effect of protocol. We are interested in the way professional relationships are influenced by protocol: between and within organisations; and most importantly with patients/clients/service users..We are accustomed nowadays to automated telephone lines, chatbots, website FAQs- the frustration of being unable to connect with another human being who will listen to our particular question and give us something other than a generic answer. The same issues that are facing society at large have changed the way in which we work as GPs and the care we give.Introduction an analysis of the different aspects of bureaucracy and regulation which influence decision making in general practice.Poppets and Parcels healthcare systems are not designed to meet the needs of everyone. This chapter is about a fundamental but undocumented component of general practice - the 'holding work' required for patients whose problems can't be solved in the usual ways, the ones for whom there isn't a simple answer.Waiting to Connect In this chapter, the stories are about flow - the flow of patients through a turbulent, over-stretched system in which access and response are often controlled by algorithm.Taking Libertiesthis chapter examines the role of GPs as agents of social control in the restriction of civil liberties - in the context of the mental health act and of safeguarding.Guidelines, Tramlines, Mindlineshow guidelines are developed and the difficulties of applying them in the messy world of general practice.The Elephant in the Roomthe stories in this chapter are about biography and biology; about medical categorisation and its effects and shortcomings.The Bureaucracy of Death In the realm of death, protocol -which has become the bedrock of clinical practice- is less useful, because the right decisions and the right timing are so individual and nuanced. These stories are about death and bureaucracy.Conclusion and AfterwordA Labour of Lovea few stories to end, of healthcare enacted with love