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​GPs' actions 'responsible for increasing patient demands', claims BJGP piece

GPs have to take some responsibility for overdemand from patients because they overprescribe and build on ‘fan the flames’ of society’s health concerns, an editorial in the BJGP has claimed.

Dr Des Spence, a GP in Glasgow, and a tutor at the University of Glasgow, wrote in the British Journal of General Practice that GPs should ‘prescribe less, intervene less and refer less’, as they are ‘fanning health anxiety’ by handing out antibiotics unnecessarily. 

He says over-prescribing is having a ‘far-reaching cascade effect on our time’, which results in a higher number of referrals and an increased workload.

The opinion piece concludes that society’s ‘health-seeking behaviour’ is a product of clinical practice, adding that the debate on workload should instead be a debate about clinical practice because ‘good medicine can only be achieved through good access, and good access can only be achieved by less medicine’.

Dr Spence writes: ’We can blame a scaremongering media, Dr Google, or those dumb popularist disease-awareness campaigns. But they are not to blame. A society’s health-seeking behaviour is in fact the product of the clinical practice of their doctors.

’The current clinical practice of us GPs is responsible for the increasing demands on general practice in the UK.’

GPs themselves can help reduce their workloads, he says: ’If we want to reduce stress and workload the solution is in our hands only. We need to prescribe less, intervene less, and refer less. This can be done at practice level by implementing non-prescribing policies, actively stopping medications, and analysing referral patterns.

’Nationally, GPs need to seize total ownership of primary care guidelines, and kick off the idiot aristocrat specialists who know nothing of primary epidemiology and project unrealistic guidance from flawed hospital-based research. Finally, good medicine can only be achieved through good access, and good access can only be achieved by less medicine.’

Readers' comments (36)

  • I hope Des has been having a word with NICE and the defence unions about this prescribing less and referring less bit. If he has I'm all for it.

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  • Vinci Ho

    Understand where you come from. Same argument to criticise BMA/GPC is too 'soft' to stand up for us. Reality is we do not have political power to overrule politicians' constant interference . So often it is about the metaphor of pointing a gun to the temple of our heads. The only political currency we have is otherwise our patients ......

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  • Dumb article in a dumb laughable journal published by a dumb out of touch medical college. In essence, this article is blatantly saying that the GPs funding the rcgp are useless crap at their job! The sad thing is that the rcgp subscribers will put up with this insult a d continue funding this pointless organization!

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  • Already started.. no otc meds for minor ailments for the majority = responsible use of resources. Careful reading of the GMS contract shows we are not required to prescribe OTC for minor ailments. While GMC requires us to prescribe in a way that uses NHS resources responsibly. This will also lead to a reduction demand.

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  • @8:08 - we have done the same and patients have been surprisingly comfortable with buying their own over-the-counter medicines.
    The odd few grumbles, but our CCG has been excellent at supporting us now, previously they were less good at supporting us.

    We do work in a relatively affluent area - so the same may not apply around the country.

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  • What a load of excrement. The author admitting he is a rubbish doctor, and extrapolating all doctors are the same? dear god. April the 1st?

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  • No one in their right mind actually reads the BJGP.

    Ditch the RCGP comrades!

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  • No one in their right mind actually reads the BJGP.

    Ditch the RCGP comrades!

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  • If you actually read the original article it us extremely sensible and has the sane ethos as the overdiagnosis and treatment group.

    However, there are several challenges to thus. Firstly, we need support from our leaders- the BMA and GPC- to stop prescribing. We do not want them to state we are in breach of contract for encouraging self care and not prescribing otc meds. Secondly, we need an infrastructure which doesn't encourage dubious patient complaints about not receiving a script/referral/investigation. And lastly, we need far longer than a 10 minute appointment to explain why we are not intervening and offering comprehensive lifestyle advice.

    That said, I always strive to medicalise as little as possible and it does reduce your workload.

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  • “… That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity.”


    Preface on Doctors by George Bernard Shaw 1909
    “Supply creates own demand when care givers make more money by providing more care”

    Jean Baptiste Say 1804

    Enough said!

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