Hats off to logical thinking on resigning from the GMS

Edward de Bono’s thinking methods have helped sort out many a circular discussion in our house. So when the question of whether or not we should resign from the GMS arose recently, due to the now familiar problem of not being able to find holiday locum cover for the practice, the logical thing to do was to examine this course of action using de Bono’s ‘Six Thinking Hats’. 

The Six Thinking Hats tool is a simple, effective, parallel thinking process that separates thinking into six clear functions and roles. Each function is represented by a symbolic coloured hat, as outlined below. The abridged discussion went something like this:

<strong>White Hat:</strong> This hat calls for information, known or needed.  The most important consideration is whether or not it would be possible to make a reasonable income without a GMS contract. Information needed includes other potential sources of income for an experienced GP in their mid-50s, current practice income and expenditure.

<strong>Yellow Hat:</strong>  This hat symbolises optimism and calls for exploration of the positives and benefits of a particular course of action. One positive outcome of resignation would be that time off  could be planned and taken as desired. Finding alternative work would not be a problem, as there is always a demand for locum or sessional work. Not running a practice would result in reduced overheads, administrative work and staff management.

<strong>Black Hat:</strong> This hat calls for exploration of all the negative aspects of a course of action. Patients may have to travel further for medical care, as it is unlikely a full-time doctor will be appointed in Killenaule. There will be more ambulance call-outs, increased and longer hospital admissions, more medication errors. The local pharmacy will reduce its staff or close. There will be job losses from our surgery. It would be difficult to explain our decision to our patients, as they are also our neighbours and friends and they have come to trust us. It could take a long time to regain that trust as a non-GP member of the community. There would be loss of the security of the GMS contract, a risk of reduced income and a risk of loss of self-esteem that comes from the perception of self as a ‘failed business-owner’.

<strong>Red Hat: </strong> This signifies feelings, hunches and intuition.  We would feel sad that 22 years of financial and emotional investment ended in failure.  Sad to finally admit that long-term personal care, by the same doctor, which has been shown to significantly reduce mortality rates, is no longer available to the people of Killenaule. Worried that we have let people down by not managing to make this practice sustainable. Fearful about such a change at this stage of our lives and uncertainty about the future.  Relief that we are no longer solely responsible for the running of a GP practice in difficult circumstances with no reason to believe that these circumstances will improve.  Happy to be able to plan time off and know it will not have to be cancelled or delayed at the last minute. A sense of freedom at releasing ourselves from an archaic and punitive contract of employment that can be altered at any time at the pleasure of the Minister.

<strong>Green Hat:</strong>  This hat focuses on creativity and growth and calls for exploration of new ideas and possibilities. Perhaps the resignation of two committed and outwardly successful doctors will help highlight the plight of Irish general practice, leading to some attempt by Government to improve it. This is probably magical thinking, but this is allowed when wearing the Green Hat.

<strong>Blue Hat:</strong> This is the ‘managing hat’ that ensures the thinking tool is used correctly and brings the discussion to a close. There are many factors to consider in trying to come to a decision, not least examination of outstanding White Hat information. We decided to re-examine our options once we had accumulated this information. 

Carrying out this exercise uncovered two important factors, the first being that we are not responsible for the current state of general practice. Failure to reverse FEMPI is one of the main reasons that there is a shortage of GPs in Ireland and until this is reversed, nothing will improve. The second is that the only reason we are still in business is that we are resilient individuals who work hard to overcome both personal and professional challenges. But resilience, while it allows us to survive and thrive, does not tackle the underlying problem of abuse of GPs by Government. Resilience has not resulted in attracting young doctors into our practice. Resilience, coupled with magical thinking, may be the reason that many of us  ‘keep on keeping on’ long after we should have quit.