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At the heart of general practice since 1960

Going for gold? Er, I’d rather not...

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I routinely reassure the anxious and posset-stained parents of pukey babies that their little precious’s stomach valve is immature and will fix itself in time, etc. But I’m seriously beginning to doubt that. Because it’s ages since I’ve worn nappies – heck, it must be months – yet my retch threshold is declining as I get older.

The latest thing to get my gag reflex is the fashion for aggrandisement among policy wonks and the great and the good. No initiative is complete without sloganeering hyperbole. Thus, we have ‘gold-standard frameworks’. And ‘RCGP champions’. And – the latest example – ‘integration pioneers’ (don’t ask).

My GO junction is so sensitised that nowadays even the mildest exaggeration of status has me hawking like I’ve got a furball. Take ‘GPs with a special interest’. The implication is that general practice isn’t quite enough for the gifted few. Jeez. We don’t need GPs with special interests, we need consultants with general interests, and until that happens I shall continue to heave at regular intervals.

Anyway, there I was, 8.30am on morning duty, checking my emails. And bugger me, there’s one about some poxy new national benchmarking scheme, ending with the words: ‘…to deliver world-class general practice for patients now and in future generations’. That’s right. ‘World class.’ Bloody hell, I think, fighting waves of nausea, who writes this crap? How can you measure on a global scale a system that is peculiar to our country? It’s ridiculous, like pitching for world-class Yorkshire puddings.

It’s at this point that a receptionist bursts in and asks me to see a man who has ‘collapsed’ outside and who is, quite possibly, ‘not breathing’. This isn’t what I need first thing. Hasn’t someone got a sore throat I could be dealing with?

I’m led to the patient. He’s unconscious, smack bang in the middle of a grassy knoll beloved by local alcoholics. A frightened huddle has gathered around.

I get up close. He has a pulse and, thank the great god of primary care, he is breathing. Having just ejected my own stomach contents over my emails, I don’t fancy CPR while he ejects his. I talk to him. Nothing. I shout, loudly, ‘Helloooo?’ Still nothing. So I resort to pressing firmly on his sternum with my thumb.

Bingo. A miracle. He leaps up, 100% recovered from his cider-induced stupor, apologises profusely, and trots off. Everyone is stunned at this apparent resurrection. It’s like I’ve performed a Vulcan death grip, only in reverse. The crowd disperses, and I know what they’re thinking. That was gold-standard, champion, world-class primary care from a GP with special superpowers.

This, of course, is bollocks. I doubt I’d have passed a CSA on managing the unconscious patient. But so what? I succeeded. I did the pragmatic thing to a good enough standard. That’s what general practice is all about. And being good enough – not gold standard, world class or any other absurd hyperbole – is what we should be aiming for. It’s realistic, effective and it doesn’t make you puke.

Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield.

Readers' comments (6)

  • David Bush

    Right on the money as usual!

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  • Bob Hodges

    Chapeau!

    "We don't need GPs with special interests, we need Consultants with General interests." - couldn't have put it better myself.

    As Kenneth Williams said:

    "The problem with medicine is that everyone is a 'specialist'. People are getting better and better at LESS and LESS. Eventually someone will be SUPERB.......at NOTHING!".

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  • Spot on

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  • I left General Practice ten years ago having been a single handed GP. Today, as an outside observer and patient (God how I hate being a patient with no power over my medical destiny) I can promise you that general practice standards of care are getting worse all the time.
    Eg 1. this week I went for a smear with the Practice Nurse. No history taken, no internal, no breast exam. I could have had uterine, ovarian and breast cancer when I walked out and no one would have known.
    Eg 2. I have to go to see my GP again this week for two problems (dodgy new mole on face, rectal bleeding and refill of Ciprofloxacin for next exacerbation of diverticulitis). Not allowed to ask receptionist for Cipro so have to talk to GP.
    Dutifully I read the notice saying only one problem can be discussed and remember how irritating it was to have to deal with more than one thing in one app. Ask receptionist for double app. Answer -we're not allowed to book double appointments aargh!
    Eg3 ask for lipid test as last cholesterol three years ago was 6.2. (Why not called in before?). Had blood test for Cholesterol only, not fasting, no lipids. Told we don't do that any more. What's the point?
    This is a highly respected teaching practice. What on earth are the rest like?

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  • The phrase 'world class' appears in every paragraph describing our Trust but yet the level of staffing is so poor that, as a nurse I find myself staying on two hours extra at the end of every shift without pay, just so the patients are safe. Also to support my colleagues who have not had a break in an eight hour shift. World class?..I don't think so.

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  • Dominique Dock

    Why would so many post anonymously?
    Copperfield may be writing as he would say it, without regards for the PCness ! but man do I love to read it !

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From: Copperfield

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