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At the heart of general practice since 1960

Half a million for doing nothing

This month, our diarist chats to a GP mate who has something of an alternative take on GPSIs and the service they offer.

http://www.pulsetoday.co.uk/practical-commissioningl

This month, our diarist chats to a GP mate who has something of an alternative take on GPSIs and the service they offer.

The story so far

Dr Peter Weaving is a GP in Cumbria and a locality lead for Cumbria PCT – a role that is at times challenging, as the PCT looks ahead to leaner times and tries to get two integrated care pilots up and running. Having a GP and PCT role also means he often gets to see things from both sides…

‘I just don't see the point of using a GP to do aspects of specialist work. They're really expensive and are much better employed doing what they're good at – seeing everyday patients with health problems.'

So says Dave, one of my partners in the practice – in fact, the one responsible for demand management – happily driving a coach and horses through the PCT's Care Closer to Home strategy.

Every practice should have a Dave. He adds gravitas to practice meetings and ballast to the summer tug-of-war. Patients love him because he's what you expect a GP to look like. The leather patches on the elbows of his tweed jacket and the threadbare knees of his corduroy pants are offset perfectly by the gold watch-chain looped into a pocket of his moleskin waistcoat and the shine on his brogues buffed weekly to within an inch of their lives. His considered approach has rescued me on more than one occasion from the bureaucratic craziness that periodically foments in any large organisation.

(The PCT's DVT pathway being a case in point – a workshop of clinical and managerial stakeholders from primary and secondary care followed by circular email iterations, which produced a beast that could only be tamed by Saint Dave, wielding the red felt-tip pen of common sense.)

‘Look at the GPSIs we send people to,' Dave continues. ‘They offer a great service, the patients love them – but they do nothing.' Dave's ‘do nothing' is a euphemism for ‘provide expert reassurance for patient and GP alike that, in their particular clinical scenario, nothing further needs to be done'.

He inhales deeply and the fob tightens across his middle like a straining anchor chain. I feel a little unhappy about the idea of my GPSI services ‘doing nothing' as I'm currently paying half a million quid a year for them across the locality.

The truth is they don't do nothing – they do loads. They are an effective, popular and economic alternative to secondary care, providing clinics in everything from dermatology to dementia.

Doing nothing is a very important action and one that doctors are not particularly good at. I was astonished to hear that 40% of our first outpatient attendances were consultant-to-consultant referrals. It seems GPs are not the only doctors who need to learn to do nothing.

‘We should stay in our practices and you could use some of your PCT's money to train us – to provide some high-quality postgraduate learning to raise the standard of general practice for all of us,' says Dave.

Before I can retaliate with a clinical pathway redesign mantra, Dave leans against the mantelpiece in the common room and fixes me with a twinkle in his eye. ‘Indeed, maybe you'd like to come back to the practice and see a few patients before you lose your skills.'

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