Tidying up some papers, I came across an article I had torn from the April 2016 edition of the BMJ:  https://www.bmj.com/content/353/bmj.i2207

I had meant to show it to our son, James who, three months earlier, had entered Britannia Royal Naval College as an Officer Cadet.  Reading it now, it seems to be more pertinent to myself and my colleagues, than to James who, happily, is thoroughly enjoying his career.

Under-investment, ever-increasing workload, increasing rates of mental illness and burnout  … these fuel the recruitment and retention crisis, that in turn increases the workload  of the remaining GPs …

… it’s a vicious circle.

No wonder then, that morale in General Practice is very low:

https://www.independent.co.uk/news/health/gps-nhs-two-in-five-plan-to-quite-survey-exeter-south-west-crisis-haemorrhaging-doctors-a7679166.html

Richard Jones’ article describes how life aboard a Royal Navy warship places the morale of its crew at the heart of all that is done: the decisions that are made; and how leadership, communication, caring for people, safety, training, and a clear sense of mission all play into the morale of the crew.

I recently agreed to relinquish my Lead GP role, now that my retirement is only a few months away.  For me, the most important aspects of leadership are communication and engaging with all members of the team.  So, I spent my Lead GP session getting to know and support the doctors, nurses and ancillary staff in the three other surgeries that had merged with Brune Medical Centre, to form The Willow Group.  Mindful of the contagion of negativism, cynicism and demoralisation within an organisation, and that “…a leader with low mood can have a negative effect,” I just hope that any benefit from my leadership approach has not been negated by my time off with work-related stress.

Recognition of the inextricable link between morale, performance and safety, is the hallmark and focus of leadership in the Royal Navy.   Richard Jones asks: “Would a healthcare manager ever consider morale when making a decision?”  The NHS has certainly espoused leadership development, but its leaders and managers can still learn a thing to two from a Navy warship in giving equal weight to morale and operational capability when making decisions that affect the workforce.

Back in the early 90s, a large number of our patients were the wives and children of men in the Navy.  Indeed, the local Rowner Estate had been built in the 1960s by the MOD for these young Naval families.  With their husbands away at sea, and their families far away, the ‘Navy wives’ had little or no family support with their children, though there was often support from their peers.  We were very aware of this lack of support for the young mums from their own mothers, and accepted that there was a lower threshold for calling on us as a result.

I was reminded of this by a recent letter in The Times:

Fri 12th October, Letters to the Editor:
GRANDMA TRIAGE
Sir, There may be an even more radical solution than asking nurses to fill in for GPs (letters, Oct 10 & 11). When faced with a similar dilemma in hospital, I often quote a paper from 20 years ago showing that, in families, the involvement of a grandmother significantly reduced the likelihood of attendance for minor problems. The clear inference being that a grandmother’s common sense and experience were all that was required much of the time.

A kindly grandmother sitting at the triage desk could undoubtedly manage many of the patients, and there might even be enough doctors and nurses to look after the rest.
Anthony Cohn
Consultant paediatrician, Watford General Hospital

Here is the original paper from the BMJ:

https://core.ac.uk/download/pdf/1670636.pdf

So, could Grandma save the NHS?   I fear that the Grandmas of today are somewhat different to those of the 1990’s, who were born and raised before the NHS was founded. They and their parents were a product of a time when access to healthcare was at a cost, and self-reliance therefore a necessity.  The attitude “Don’t bother the Doctor” was the norm.  No-one can deny the huge benefits of ‘free healthcare at the point of access’ – the mantra of the NHS, which has made the NHS the most valued institution in the UK.  However, one unforeseen consequence of such free access, is a progressive deskilling of successive generations.

Over the last two decades, successive governments have prioritised access, and fostered – if not encouraged – a consumerist approach.  They have used access targets in primary and secondary care, waiting time targets in A&E, Gordon Brown’s Extended Hours, and now the latest expansion of GP services: GPEA (GP Extended Access).   Already stretched services are expected to stretch even further.

“I don’t want to bother the Doctor” is a rarely-heard refrain now, and restricted to the very elderly.  Thankfully, “It’s my right” is also rarely said (though perhaps more often thought), but there is no denying that patient/public expectations have increased hugely over the last two decades.

Grandmas of today, both individually and collectively, have such an important role in their families and society.  Despite what I have said about the change in experience and expectations, and the deskilling of more recent generations in the management of minor illness, some could certainly provide an effective triage service for minor illness.

So, there you are Messrs. Hunt and Hancock: with a little smoke and mirrors, you can hide the unrealistic promise of 5000 more GPs by 2020, and build a workforce of Grandmas to ‘man’ 111, Same Day Access Services, and A&E Triage …

… sorted!