What is the incident or experience that’s had the most impact on you in your career, and why?
Two things have had a huge impact on me.
The first was when I was 19. I was a medical student at Cardiff and came home to Preston to visit my mum in hospital. She had heart failure, looked very unwell, and I remember asking her if I should stay with her or go back to medical school. She said: “Of course I want you to go, I want you to be a doctor. Don’t you worry about me.” So I did go.
She died five days later.
She had always wanted me to become a doctor and I know how proud she would now be. Her telling me to go at the expense of being there for her death had a huge impact on why I chose the career I did.
The second experience was when my GP partner died. He was my best friend and mentor, but was taken from us through suicide. It was an absolute shock. I was the one who found him, and I’m the GP I am today because of him. In the six years since then I’ve run the practice on my own, and I’ve found the courage to speak out about things when I feel they need to be said. I’ve got more feisty.
What have been your main observations as a GP during Covid-19? And to what extent do you think any changes in general practice will continue once the crisis passes?
While being a tragedy, Covid-19 has given us a freedom to innovate that I’ve never before experienced as a GP. In my own practice, we embedded total online triage in three days and came up with innovative ways to reduce face-to-face time between staff and patients. The pace of change and the shared learning among GPs through social media groups has been phenomenal – a reflection on the best of humanity.
I hope we never go back from online and telephone consultations as the first point of contact. It’s easier for patients with no travel time or sitting in waiting rooms, and enables them 24/7 online access to their GP for non-urgent problems. Remote and flexible working has also been well received by staff, which will help us retain and recruit the future workforce.
Going back to the way it was would be a huge backward step.
What do you believe are the biggest risks to the possible success of PCNs?
We are trying to both sustain and transform general practice at the same time – we’re trying to build the plane while flying it. It would be great to have time and investment to strengthen general practice first. It’s the process at fault, not the goal.
I’m a big advocate of PCNs – they are a real opportunity to join so many things up. But the risk is that general practice isn’t currently strong enough, GP morale isn’t strong enough, and the workforce isn’t there. If we lose GPs’ buy-in for this, we are going to lose the whole thing. And if PCNs fail, ICSs will fail.
What do you believe is the biggest risk to continuity of care in general practice? As a GP, how important do you consider that continuity?
It’s not 1948 anymore. There is a shortage of GPs and people are living longer. No one has time to do the leisurely GP home visits where you might pat the dog or catch up about the kids. But of course continuity is important. Your referrals and prescriptions are often lower if you know the patient. I may know that Mrs Bloggs has just lost her husband, meaning her chest pains are probably heartache rather than cause for a cardiology referral.
Yet in the wider picture that is probably more satisfying for both sides than it is essential. I think the solution lies in team-based care, on which PCNs will help. If we lose continuity that is not team based, it will just put costs up in the NHS. We already see this with locums – more referrals and prescriptions, more single episode medicine and less satisfaction.
What is a hidden danger to the NHS that you see ‘bubbling up’ in the next five years?
The mental and physical health of young people. We’ve got new societal illnesses.
When I started as a GP, I don’t recall 15-year-olds stabbing 15-year-olds. We now have victims of other violence too. There is also no diagnosis yet of stress by Instagram, but we have a whole load of teenage girls spending their lives worrying whether they look cool enough on it. These are illnesses I’ve never seen before.
We are conscious that our elderly are living longer and we are concentrating on their care, but I don’t know how we are going to manage that demand around younger people.
What could or should be done to improve diversity in the NHS?
I would like to see more BAME women like Dr Nikki Kanani in senior roles. I really look up to her. She is a mum, she is an Asian woman.
At this year’s Nuffield Trust summit, a dentist I’d never previously met came up to me and said: “I heard you speak and I wanted to say hello, as it’s really nice to meet someone like me.” She was wearing a headscarf and I thought that was really interesting. Human beings still like to see people who are like them. It makes you think: “I can do it as well.”
What don’t you feel that those running the NHS appreciate/understand?
Just because people want a GP appointment, it doesn’t mean they need one. I don’t see the value of putting a number on so many extra appointments – there is so much that just doesn’t need to come to the GP.
“Access is the thing” is a people-pleasing message but we are not empowering communities with it. We should be using our community assets better to make sure people are going to the right place – whether that’s the nurse, the voluntary group, or having a cup of tea with a mate. That might be what they need, rather than coming to me.
What do you think is the NHS’s biggest mistake?
Number one: not learning from things that have gone wrong. Number two: wanting it all today. Shiny things come and go because we wanted instant results and didn’t give them enough time to work. But then we do more of the same.
We have to learn in health because it’s so important. The most precious gift anyone can have, apart from food and water, is your health. You can see that with Covid-19. You can close gyms, cinemas and even schools, but hospitals and practices will stay open. At this year’s Nuffield Trust summit when Nigel Edwards was describing how much we have – and haven’t – learned over the past 40 years, I just thought, “I’m going to be 87 in 40 years. I don’t want be hearing in another 20 years that nothing has moved much”.
Dr Farzana Hussain has been a GP in east London for 18 years and runs her own practice, The Project Surgery. In November, she was named GP of the year at the General Practice Awards.