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A faulty production line

Devon GPs' 'don't come to us' leaflet didn't go far enough - so I wrote my own

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I’d like to send a letter of congratulations to the practice in Devon, which had the genius idea of sending its patients a leaflet outlining local services that don’t require a GP referral, but I can’t, because NHS England would probably object to the wording and stop me from sending it.

Just as they did with the leaflet, in fact, which is odd because a) By the sounds of it, this brilliant innovation would have sped up access of patients to relevant local services while relieving the practice’s workload, thereby freeing up appointments for those who really need them, and b) I hadn’t realised that we’d sunk to the point where NHS England censors our communications to patients.

My only criticism would be that the practice didn’t go far enough - somewhere, inspired by their example, I now intend to go. So here is the leaflet I’ve devised for my patients. Feel free to photocopy and adapt as you think fit.

‘Dear patients,

I’m up to my man-boobs in sodding work, so if it’s okay with you, I’d like you all to bugger off and terrorise some other poor sod for a while. Say just for the next six months or so, while I have a bit of a catch up?

I’m not leaving you in the lurch, though, because there is a whole heap of services you can pitch up to without a note from me. True, I do all the things they can do and better but frankly, I’ve had enough.

So before you even think about trying to book an appointment with me, please consider whether you would be better served by one of the following: A&E, an ambulance, a taxi, your consultant, PALs, physiotherapy, speech therapy, audiology, occupational therapy, any sodding thing with ‘therapy’ after it, an osteopath, a chiropractor, the dietitian, a social worker, a health visitor, the midwife, the housing officer, the job centre, the citizens advice bureau, public health, the GUM clinic, the Red Cross, your MP, the priest, the exorcist, the community psychiatric nurse, the community nurse, the community paediatrician, the community geriatrician, the community drug and alcohol team, the admissions avoidance team, the avoiding the admissions avoidance team team, a matron of some description, the mental health crisis team, the crisis avoidance team, the crisis creation team, the Macmillan nurse, the palliative care team, the undertaker, the ambulance service, the defib which is on the wall by the main entrance of the village hall (you know, down that road near the new supermarket, by where that garage used to be - what’s it called?), the vet, the priest, the complementary therapist, the COPD team, the stoma nurse, the incontinence nurse, the continence nurse, the intercontinental continence/incontinence nurse, the infectious diseases control nurse, whatever the tissue viability nurse is, Alcoholics Anonymous, the counsellor, a councillor, God, your hairdresser, a chiropodist, a podiatrist, the dentist, the optician, the pharmacist, a butcher, a baker, a candlestick maker, and anyone else who knows me.

But not NHS 111, obviously.

Love and best wishes,

Dr C’

And if NHS England takes exception and wants to pay me a visit, I can assure them of a warm welcome. I’ll be the one holding the flame-thrower.

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

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Readers' comments (30)

  • Simply Brilliant!

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  • Secure environments GP

    Fabulous..Too much is expected of GPs, who I feel sometimes are expected to do all those roles you mention (well perhaps not exorcisms).

    There needs to be boundaries set. A practice attempting to set sensible boundaries, guide patients to use more appropriate NHS resources is correct and proper. In fact important for delivery of safe and effective services for those who "need" them.

    Why should we be permitted to educate patients and this includes guiding our patients to self-refer to certain selected services?

    I currently work a 12- or 13- hour day, amounting to 40 or 50 patient contacts, visits, as well as letters, prescriptions and so on. I work until the job is done. I try and set limits, but frequently when I do so patients get disgruntled if I ask them to rebook for the 4th and 5th problem.

    General practice is being "broken" by underfunding, by overworking NHS staff, bullying by the Press, unreasonable expectations by the public, by clinician burnout, early retirement and emigration. What is to replace it?

    £73 per year per patient can no longer fund comprehensive care for a year, all you can eat, unlimited appointments etc. The model must change.
    ( As an aside, it costs me £430 a year to insure my dog, then there is a 20% copayment because he is is old ! )

    So some exhausted Clinicians have been pushed past their limits of human endurance and are dis-engaging whilst the Govt and NHSE over-regulate, impose change and yet more re-organisation.

    It is to be applauded when a practice takes an overview of local services and its own capacity and takes steps in overcoming organisational barriers to good medical practice.

    They are responding to patient Unmet need which of course is an inevitable consequence of a unprecedented funding squeeze for years.

    They are responding to risks of "getting it wrong" for individual care by understanding about the environments from which complaints arise.

    They should be assisted and supported by NHS England to help them overcome the challenges they face when difficult choices must be made about practice funding priorities.

    It is so sad that this needs pointing out so bluntly; that overloading GPs is unsustainable. Failing to attend to the needs of one group of patients (doctors) does nothing to benefit the wider population.

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  • Secure environments GP

    Meant: Why "shouldn't" we be permitted to educate patients and this includes guiding our patients to self-refer to certain selected services?

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  • David, very eloquently put. How about an open letter to this effect via the press to NHSE?

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  • Patients would love to self-refer too - but are always sent back to their GP

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  • Secure environments GP

    NHS England Area Team are meeting with the practice today, so I gather, so we shall see what happens next.

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  • Very funny , go on send it they'll love it !but also very useful....if only people knew how much they can self refer ! Traditionally GPs have been the gatekeepers to all services so many people simply don't know they don't need to see the GP first. The only self refer service that gets any publicity is the pharmacist .not even the candlestick maker gets a mention

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  • ... I have had a consultation requesting an exorcism in the last 10 years! Spooky!

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  • Please add a new one to me ..The Hearing Voices Clinic !

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  • Thank you for the laughter!

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From: Copperfield

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