Editorial

Completing the Educational Supervisor’s Review (ESR) can be a mixed blessing. However, it is always a pleasure to read glowing feedback on trainees and this happens a lot. Heartfelt and enthusiastic feedback achieves more than encouragement for the individual, it represents hope for the future and even the prospect of a recommitment to the founding principles of the NHS. At a time of crisis and challenge for the NHS we need to have hope and a plan. We may not remember the details of Aneurin Bevan’s vision of 1948 emerging from the societal shock of the Second World War and a commitment to better healthcare for all from regular taxation, but the commitment and ethical principles are often evident in feedback on the professionalism of a new generation of GPs. The British Medical Journal has called for the declaration of a national health and care emergency with a recommitment to the founding principles of the NHS and the revival of hope for a better, fairer and healthier world (Smeeth et al., 2024). How is this achievable?

ESRs often give evidence of individual triumph in the face of adversity, but also of moral distress and the challenges of working in a poor environment with inadequate resources. For example, reviews of clinical cases often reflect a deficit in the provision of specialist care for patients with mental health problems, in parallel with an epidemic of problems associated with mental health. GPs find themselves trying to bridge the gap in provision of specialist care at a time when more patients are facing more of the kind of mental health issues not needing specialist referral. There are similar gaps in resources across other specialties with consequent impact on the quality of care achievable. Unsurprisingly, the NHS now ranks low on clinical quality outcomes. In election year, the cacophony of demand for a new NHS plan is rising, but regular evidence of professionalism gives hope and maintains faith in the ethos and popular founding principles of the NHS.

Having completed the ESR I turned to the newspapers with the usual low expectations of good feedback for GPs or hope for the NHS. Newspapers seldom give hope but can raise readers’ expectations! But hang on! Here is an interesting account from a young journalist of his experience as a patient in the NHS. A family history of colon cancer and some rectal bleeding prompted him to seek help. In short, the account was of familiar, lamentable NHS administrative underperformance, but of much gratitude for the professionalism and compassion from the nurses and doctors involved. More hope and encouragement?

Whatever the external circumstances of our working environment, we must try to maintain a high quality of care for patients presenting with a myriad of problems. Paul Silverston reminds us how diagnostic errors occur and how, particularly in primary care, these are inevitable but preventable. Elizabeth and Rodger Charlton provide a practical approach to helping patients with personality disorders, another challenge for GPs grappling with a lack of resources for better mental health. Niamh Blythe describes chronic primary pain, a new diagnostic entity we may be familiar with, but better insights, we may not. Vascular dementia affects more of our patients every year and Muataz Khalid gives an account to help with diagnosis and management. Fergus Wood and Rungphloy Jaroenchasri review the causes and treatment of otorrhoea, a common and familiar presentation. Joseph Morwood provides insight into the issues surrounding use of drugs by athletes, an example of a problem less common in primary care but demanding knowledge and understanding.

Professionalism, hard work and empathy are evident in the performance of many trainees and feedback from colleagues and patients suggests these qualities are highly valued and prevalent. It is obvious that such qualities are integral to good care in the NHS and appreciated, of course by patients. Let us hope that any new plan for the NHS to meet the challenges of a growing, ageing population value the professional commitment of colleagues and trainees. Recruitment and retention of a skilled NHS workforce needs a plan to improve morale, strengthen professionalism and reverse the sentiment behind a year of unprecedented industrial action. And what of the ESR? Excellent, as we hoped, and meeting the expectations of further development for licensing as fully fledged, hard-working, empathetic and thoroughly professional colleagues. Sounds like a plan ….