If you ran the dishwasher and cleaned the kitchen every time you used a single dish, you’re going to spend most of your life cleaning the kitchen.

On the other hand, if you wait until every dish you own has been used and they are piling up in the sink, and the kitchen is filthy, you’re going to spend most of your life living in squalor.

 There’s a place somewhere in between those two extremes that is the optimal steady state.

 In any system, we need to set the triggers for action, then act accordingly.

 Medical staffing has currently missed every trigger for decades. When burnout got to one in two doctors, we didn’t act, and it’s now at two in three. As the workforce has aged and is now retiring, we didn’t act, and general practice, in particular, is well past breaking point. As a younger generation of doctors voted with their feet and left the profession rather than put up with inhumane hours, we didn’t act and instead just worked the ones who stayed harder.

 Waiting for a crisis, as we have done, is risky and comes with extreme consequences in a profession like medicine. We need to get clear on the triggers, which we didn’t, and we need to act accordingly before we reach breaking point, which we didn’t.

 I want to be very clear though, this is not the front line dropping the ball, they are the ones suffering.

 This is dropping the ball at the top for decades and not allocating the required funding and resources to the front line.

 We’ve relied on the goodwill of the frontline and their commitment to their patients as a Band-Aid to systemic underfunding, but the Band-Aid is now falling off.