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Medical Leadership in the 2020s - Dr Mark Burgin

23/09/19. Dr Mark Burgin BM BCh (oxon) MRCGP explains how medical leadership has been behind the curve when reacting to the crises that are facing the profession.

The 2010s have not been a good time to be a doctor with burnout rates over 50% across the western world and closer to 90% amongst UK GPs.

Pay has remained competitive but has failed to keep up with natural wastage despite additional funds being offered to older GPs who stay on.

Medical leaders have largely sat on their hands offering little beyond suggestions that working together in large groups will somehow make up for empty surgeries.

Repeated denials that increased workloads in secondary care is due to a less efficient primary care service has led to sense of unreality about the crisis.


General Practice needs about 45k doctors to catch up with demographic changes in medicine, the population and replace the older workaholic doctors who are leaving.

Simply increasing medical school and GP training will not replace those who will leave anyway never mind those who will leave if things do not improve.

The only practical solution at this time is to offer 10K jobs in General practice for apprentice GPs with a £50k pa pay tag so that every GP can have a trainee to take the load.

This will both fill the hole until other solutions can found and provide experience of working as a GP to thousands of doctors who may have negative opinions of the profession.

Research and Education

There has largely been a collapse in quality research in Primary Care, with a few notable exceptions, for the last 20 years especially in the UK.

There is no study looking at the use of the Biomedical Model and burnout in GPs or why some GPs refer less psychologically sick patients than others.

Educating GPs to use the disability analysis in sickness certification and how to manage psychosocial risk factors to prevent disease has not occurred.

It is time for the medical leaders to set the agenda by headhunting those who have ideas to set the questions and campaigning for research to answer them.

Psychosocial risk factors

The emotional heart of General Practice is the management of psychosocial risk factors by understanding the whole person and their life.

GPs simply do not have time to spend with their patients as they firefight complexity so adding another 5 minutes to the consultation will not help.

The medical leaders should be calling for guidelines, targets and monitoring to be suspended whilst GPs get the situation back in control.

They should call for managers to review their strategy and understand that the Triple Aim needs timescales in decades to be suitable for primary care.


The medical leadership is dysfunctional and is failing to take the simple steps necessary to deal with the crisis; give all GPs the power to recruit doctors to help them.

Give GPs back their pride by doing real research that addresses the important questions like why are GPs so cost effective and how do they do it?

Recognise that the Triple Aim and all the short-term guidelines make sure that most patients get the wrong treatment because there is no one-size-fits-all … patients are individuals.

Letting GPs care about their patients is not just some touchy feely idea but is the way that high quality care is delivered in a modern evidence based health system.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website

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