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Forget 'Going for Gold' - just let GPs give patients the death they deserve

Copperfield's trapped in the lunchtime meeting from hell. At least there are bananas and Tetris...

Copperfield's trapped in the lunchtime meeting from hell. At least there are bananas and Tetris...



Monday lunchtime meeting time again. Another dash home after morning surgery for a rushed cheese sandwich and a Coke Zero – the better part of which ended up in the passenger footwell as I sped over a series of sleeping policemen in an effort to get back to the health centre for a one o'clock start.

I leaned over to the practice manager who was seated on my left and whispered conspiratorially, 'You lying ************. You told me that today's jolly would be worth turning up for.'

'Listen ********, you have to be here. It's a QOF thing. So settle down, eat your banana and if you must play Tetris on your mobile phone at least turn the bloody sound off.'

While this witty exchange was in progress, around the room sat a selection of nurses, F2 doctors, embryonic GPs, a new dead-keen GP partner and a couple of receptionists who'd wandered in for the free monkey food and found themselves trapped in the corner furthest from the door when the meeting was called to order.

Four and a half minutes in, their eyes were already glazing over. This is the reality of the 'National Gold Standards Framework meeting'.

A list of names churned out by the practice computer – patients who we wouldn't be surprised if they died within the year. Just for sport, a couple already have, but no-one has got around to telling the IT folks yet.

Elegantly proving that typing 'Gold Standard Care' into someone's file doesn't actually imply that they're in receipt of any such thing.

My TLC crew's names don't appear on the list at all, because I've been using vague and nebulous diagnostic codes like 'Terminal Illness' and 'Form DS1500 completed' that the QOF harvesting software can't find. But I know who they are, they know that I know who they are and, frankly, spending thirty seconds discussing their case with all and sundry isn't going to impact much on their day-to-day lives.

Copies of the primary care briefing paper are handed around, eight pages of nothing much that we don't already know, amusingly entitled 'Going for Gold'.

And our thoughts turn to long lazy afternoons of daytime TV with Henry Kelly, resplendent in a jumper even woollier than the Gold Standards Framework itself, asking a quartet of contestants, 'What "C" am I?'

And even the non-English speaking contestants could join in with the answer to that one…

I've nothing against good terminal (or, as we're supposed to call it now, 'end of life' ) care – and I'll admit that patients, for one reason or another, don't always get the deaths they deserve. But dressing the topic up with buzz words like 'embedded as mainstream', 'affirming success' and 'passport information' just makes those of us who actually do the work feel like we're on the receiving end of another year's production figures at the tractor factory.

I once overheard a patient tearing a strip off a well-meaning social worker who referred to him as 'visually challenged'.

'Don't you devalue my experience pal, I'm f***ing blind…'

Patients are not 'choosing' the time and place of their deaths. Otherwise, like most of us, they'd choose to die watching the sunset over Saturn's rings sometime in the year 2355. And they don't give a stuff about the Seven Cs (eight if you count Henry Kelly) or the PEPSICOLA mnemonic for their monthly 'Not Dead Yet Then?' reviews.

I'll even wager that most of them would want us to do whatever we could for them and then devote some time to the rest of our patients rather than spend hours sitting through meaningless meetings or glued to the DVDs included in the Quality Improvement Training Packs that come complete with workbook, dot-to-dot puzzles and pages for colouring in.

But what do I know? I'm a banana and a QOF point up. And my fourth best ever Tetris score too.

'Sick Notes' by Dr Tony Copperfield is out now, available from Monday Books.

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