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GPs buried under trusts' workload dump

​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)

  • We have been here before - those of us with long memories will remember Ivan Illich. There is some truth to this but but try listening to the today programme as I do on the way to work every morning. Its content is saturated with health stories all stoking health/sickness consciousness and anxiety.

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  • There is always two sides to an argument - and it is encouraging that some commentators are prepared to see that. Nothing is ever black and white - but it seems wrong to rubbish an opposing view without at least some reflection.
    With 7 GPs to manage I can readily tell you which two prescribe the most, have the highest referrals and have GP-dependant patients - and yes, I do field spurious complaints from time to time about the others who didn't give otc scripts etc - but I also see which patients return time and time again to which two - and, amazingly, when they are on holiday those self same frequent attenders can manage to go two or three weeks without seeing anybody else - and they are still alive !!!!
    Okay. I can hear the cry now - I'm only a simple manager and don't know anything clinical and have no right to comment.
    Maybe. But good clinicians are also managers - and good managers must have awareness of clinician behaviours.
    Give the article a chance, as some clearly have, and who knows - there might even be improvements in patient outcomes...........

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  • DrSpence has just made another of those generalisations belonging to those issued by the Academy of the Blindingly Ovbvious and which as such clearly has some truth in it.It takes little thought to see how underwhelming and less than profound the statementreally is. How appropriate it is will depe nd on a plethora of unmeasurable contributions dependant on largely uncontrollable circumstances;such as statements made by employees of some of the contracted out services to the NHS which have a financial interest in reattendance."Make sure your GP refers you back if a,b,c etc worry you" is a favourite.
    His statement is rather like saying that death is due to sepsis. It gets him mentioned a bit though.

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  • DrSpence has just made another of those generalisations belonging to those issued by the Academy of the Blindingly Ovbvious and which as such clearly has some truth in it.It takes little thought to see how underwhelming and less than profound the statementreally is. How appropriate it is will depe nd on a plethora of unmeasurable contributions dependant on largely uncontrollable circumstances;such as statements made by employees of some of the contracted out services to the NHS which have a financial interest in reattendance."Make sure your GP refers you back if a,b,c etc worry you" is a favourite.
    His statement is rather like saying that death is due to sepsis. It gets him mentioned a bit though.

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  • If you want to reduce costs for the system and reduce medicalisation, then gear the legislative, quality assurance and regulatory bodies to encourage this, and to protect professionals who try to achieve this.

    However, at present, the system is ABSOLUTELY NOT geared to this currently. Therefore we all drown in work because we practice defensively. I agree that it creates more work, and more repeat work, but the GPs who get the least legal challenges, and the least indemnity issues are those who have high rates of referral, prescribing, and run late.

    I'm cynical, but the cause and effect of what the DH has done to us all is self-evident.

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  • If you want to reduce costs for the system and reduce medicalisation, then gear the legislative, quality assurance and regulatory bodies to encourage this, and to protect professionals who try to achieve this.

    However, at present, the system is ABSOLUTELY NOT geared to this currently. Therefore we all drown in work because we practice defensively. I agree that it creates more work, and more repeat work, but the GPs who get the least legal challenges, and the least indemnity issues are those who have high rates of referral, prescribing, and run late.

    I'm cynical, but the cause and effect of what the DH has done to us all is self-evident.

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  • Practice Manager 11:17am is completely correct.

    Every practising doctor knows that we are contributing to an epidemic of dependency, passivity and entitlement - re-enforced repeatedly by the media, politicians, the contracts that we are bound to, the medico-legal situation and the benefits system.

    Des Spence is a brave man - but any clinician that follows his advice in the current climate has failed to understand the current climate.

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  • Practice Manager 11:17am is completely correct.

    Every practising doctor knows that we are contributing to an epidemic of dependency, passivity and entitlement - re-enforced repeatedly by the media, politicians, the contracts that we are bound to, the medico-legal situation and the benefits system.

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  • Vinci Ho

    Would like to hear Des' view on Prep , the HIV prophylaxis drug which is in the centre of a court battle between NHSE and campaigners....

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  • Vinci Ho

    Would like to hear Des' view on Prep , the HIV prophylaxis drug which is in the centre of a court battle between NHSE and campaigners....

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