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At the heart of general practice since 1960

A tale of two surgeries

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Picture two surgeries. In Surgery A, you see patients to discuss cardiovascular risk, manage chronic disease, tweak statins or antihypertensives, screen for dementia, assess risk of diabetes, dispense lifestyle advice, plan admissions avoidance strategies and so on.

In Surgery B, you see patients with coughs, cystitis, abdominal pain, headache or a combination of all these; patients with symptoms that make no sense or defy description, patients worried about cancer when they shouldn’t be and not worried about cancer when they should be, and so on.

Increasingly, we’re expected to run Surgery A, which was not in my original job description. Problem is, we’re still running a teeming Surgery B, which was. So we’re running two surgeries at the same time. If you feel you’re twice as busy and ageing twice as fast as before, that’s because you are.

No worries, say the movers and shakers. The direction of travel, to use the current vernacular, is away from Surgery B towards Surgery A. Apparently, Surgery B can be deconstructed, then delegated or diverted – to pharmacists, physician associates, open-access cancer investigations and so on. That frees us GPs to get on with the complex/chronic cases in Surgery A, which, according to the mantra, requires skills only we possess.

There’s just one problem with this: it’s bollocks. They’ve got it completely about-face. The truth is, we’re a far better fit for Surgery B – and not just because the alternative is so unremittingly tedious that, within half an hour, any reasonable GP would be chewing their CQC-approved floor covering. 

Screening, chronic disease management, lifestyle advice, diabetes prevention and all the other public health crud being tipped relentlessly into our laps at least has the benefit of a skipload of guidance to steer, flowchart-style, whoever ends up doing it. So Surgery A, far from requiring GP superpowers, could actually be handed to just about anyone who doesn’t currently need half-hourly neuro obs.

Conversely, dealing with people who are, or think they are, ill cannot be done by protocol. It requires knowledge, reasoning, judgment and gonads of steel. True, it involves wading through trivia but that’s not an indictment of the system, it’s a description of the territory. Try farming Surgery B out elsewhere, and you end up with an expensive, ineffective and dangerous mess. Any dissenters to this argument should just try dialling the numbers one, one and one.

So I have a message for the newly reinstated health secretary who, apparently, is on a ‘mission’ to improve GP services. First, Jezza, you’ve got find a few thousand GPs, but until you remember where you put them, you could sort out recruitment and retention if you stop turning us into public health lackeys. Give us space and time to breathe and to get on with being GPs, because we could do it brilliantly if you’d just bloody well let us.

A ‘step change’ in GP services? Sure: as long as it means putting that direction of travel into reverse.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield.

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Readers' comments (11)

  • Totally agree with you Tony, and to add, reduce demand for Surgery B

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  • I totally agree with this blog. I am very impressed how it accurately and clearly summarises the current culture in general practice so well, in just a few paragraphs.
    Surgery A fits with a privatised corporate market based health system; Surgery B is part of the previous NHS universal health care model.

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  • so let's stand up and be counted and try and not comment anonymously , especially when agreement...it is traceable via ip-address anyway if someone wanted to find out...remember the NSA - the American agency with the motto : Never Say Anything- and the lot....not many of us know how to bounce staff around the global tinternet.....
    Tony, if ever you need any help ,GMC, police or other....let's promise to stand by either and defend our profession ,defend our vocation. Jezza never had to worry about money or anyyyything , he was born with silverspoon in his mouth as the saying goes in the UK

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  • I would like ' volunteer ' Tony to run the @common-sense-task-force for the nhs. Like helium it can not be generated and we are ' wasting ' at lot of helium every time we decide to order a just-in-case-MRI . Helium is used to cool these machines and yes, it turns your voice squeaky but ...so common sense to be finite, so the growing population on our planet will have to do with less. The punters never complain of lack of common sense because it is a lack they can not feel because etc etc...so dishing out advice to people that come to you for perceived or real problems or even just a letter to the housing association people .....we only ever take the advice we ant to hear (and that's the staff and fellow GPs included )....

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  • Fair challenge re identity Anne.
    This is one of theist perceptive explanations of where GP value lies I have seen. Thank you.

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  • Typo sorry 'the most perceptive'

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  • Have a resounding round of applause from me, Dr Copperfield. The guidelines and hoop-jumping and box-ticking have killed my love for general practice in a way that no amount of triviatrics liberally sprinkled with actually or potentially serious medical problems could ever have done.

    Is there anyone out there who isn't too busy and exhausted to get stuck into the task of turning the clock back and reclaiming our territory and making general practice truly rewarding again?

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  • Drachula

    I would love to. Have just lost my job as a partner (long story) and am champing at the bit to make a difference. But is there any real chance we can?

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  • " The only needed for things to go wrong is for one person not feeling the can stand up and be counted .".this is a Goethe quote ( the German geezer /poet )....I have been 'investigated by the GMC in the past ( complaint : you ( as in me )suffer
    from BAD ( only I'm am truly unipolar, as in high and very high, so high ,as in ill )
    My father a teacher and professor used to say
    " if people worry about the cost of education they should talk to the people that worry about the cost of NOT educating people but you rarely find them in the same room ( Plebs in Latin means
    people/Volk /Voelker )
    Same goes for the nhs .Alyson Pollock ( not sure about name ) who wrote nhsplc same years ago points out that exchanging money for delivery of health service is a new concept.
    We dot not have a right to a health system that is free at the point of delivery or a " right to good health otherwise I'll call my lawyer " ....otherwise it would have been enshrined in the US ( just after the right to wear arm ..)

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  • Philip Pritchard

    This is the Absolute TRUTH about General Practice today.
    There are two types of Doctor as well. The ones that look after their patients (Surgery B)
    and those that look after themselves (profits) Surgery A

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder