When it comes to the NHS, the reality is that our system of government allows new dictatorial edicts to be uttered from on high without any true sense of conversation or relationship with those who work in the system. There is still a belief that this is how change effectually happens. Unfortunately it causes schisms, distractions away from the work we need to do, worsening care, the constant disruption of culture and low morale. However, although protest is vital , and demonstration is key (and had I not been doing a clinic last Saturday morning, I would have been marching in London to support my junior colleagues), there are alternative ways to operate which have the potential to bring about change. One way is the pattern of subversion and submission.
When it comes to the idea of 8-8 7/7 working, the government have General Practice over a barrel and they know it. The prime minister himself has announced that this is what he wants to be remembered for (possibly too late after pig-gate!). The health secretary has declared his intentions in the House of Commons and the national media has thrown its support behind the initiative. The fact that we already have 24 hour cover, 7 days a week, provided by GPs throughout the country is irrelevant. The lack of evidence base, lack of GPs available to work these extra hours or indeed the lack of finance to fund it adequately is not allowed to be important here. The health secretary is able to twist clinical evidence and use statistics of his choice to mislead parliament. One could even be cynical enough to believe that the government are trying to demonstrate again and again just how ‘nonviable’ the NHS is, blaming the “greedy and lazy” doctors for its inevitable collapse. But as the graph shows us, the work of GPs has risen beyond any expectation in the last 20 years and there is plenty of evidence to show how significantly pay, both for GPs themselves and the resources needed to provide the increased level of community care, has fallen in the same time period. These facts are being shouted from every social media rooftop, but they will fall on deaf ears at Westminster. Whether we like it or not, this change is going to happen to us.
Those of us, who work in General Practice and took a 20% pay cut to not work weekends will absolutely have to do so, or we will be squeezed into a corner in which our practices fall over due to under-funding and staff shortages (which some believe is what the government want to happen). I understand the anger and the anger is not wrong. Feeling undervalued and misused is really horrible. But we are better than being vitriolic. We do not need to dehumanize those who we feel to be our oppressors, even when we ourselves feel dehumanized. GPs need to continue finding clever ways of subverting the dominant reality, demonstrating just how ridiculous it is and then get on and submit to it. This is true power. This is the way of love and this is the only thing in the end that ever changes the world.
Our business is in delivering continuously improving, high quality, compassionate healthcare to everybody in our community, while we can. And if we all fall over trying to do this from hearts of love, then the spectacle will not be us, it will be the powers who have crushed us and they will look ridiculous. It may not happen in this generation, but at some point, some people have got to be brave enough not to fight fire with fire, but to choose the better way, the path less travelled by, the way of life laying down love. This is the way that opens up a different kind of future. We need to strengthen each other to be resilient and creative enough to find this better way.