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Independents' Day

If I go down, the NHS goes with me

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Patient #1 has been feverish and achy since yesterday, so I send him to the Medical Assessment Unit to rule out sepsis.

Patient #2 has had diarrhoea for 10 days, so I do a two-week referral to exclude colon cancer.

Patient #3 has a sore throat and cough, so I give him a week’s worth of amoxicillin.

Being a GP can feel like having to smile serenely at everyone while being punched repeatedly in the face

Absolutely no complaints from the punters, and no prospect of any, either. Whereas I assume you’re howling in protest. And quite rightly, too. Because the above scenarios are, of course, a pack of lies. In fact, the first patient received advice, the second was given my standard gastroenteritis patter and the third got a flea in his ear. Plus safety-netting, of course – except patient three, because it’s hard to safety-net after ‘sod off’.

But there’s always that nagging doubt, isn’t there? Because #1 might actually turn out to have sepsis. And #2 could conceivably have bowel cancer. And #3? In some cruel, anti-GP parallel universe, #3 could go on to develop life-threatening pneumonia, just out of spite.

Should any of these catastrophes occur, there’s a fair chance that, despite my safety-netting, I’ll receive a complaint for failing to send to hospital/refer to outpatients/prescribe. Doing ‘nothing’ may be spot-on clinically, but is a high-risk strategy unless you actually enjoy subsequently fending off pages of green-ink underlined capitals berating you, your attitude and your competence. Ever heard, on the other hand, of a GP getting a complaint for doing too much? Nope, me neither.

And this is the point. For years, we GPs have been experts in – and shouldered the burden of – uncertainty. We bear the stress of alternative diagnostic possibilities so the patient and the NHS don’t have to. Otherwise, we’d practise medicine so defensive that patients would be angst-ridden, poly-investigated and overtreated, and the NHS would implode.

The result? Being a GP can feel like having to smile serenely at everyone while being punched repeatedly in the face. Our rewards for taking on those risks and responsibilities have been increasing stress, a rise in complaints, rocketing indemnity fees and a spiralling media hate campaign.

So the news the Government plans to cover inflationary rises in medical defence subs is a welcome break from the beatings, even if, as ever, it has all the hallmarks of being hastily scribbled on the back of a departmental envelope.

Now, I don’t want to suggest, like some sanctimonious compensation-seeker, that, ‘It’s not about the money’. With defence subs, it most certainly is about the money and, frankly, we need something way beyond an inflationary top-up. But I want more. I want this to mean ministers have actually started to get what GPs do every day, and do so well. I want them to grasp that, were we to protest by referring and prescribing every time to save our own skin and sod the consequences, we could bring the NHS to its knees.

In other words, I want them to appreciate the cost. But what I really want is for them to acknowledge the value.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

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Readers' comments (27)

  • Nurse practitioners - it's always the GPs we hear from think the NPs behind the GPs also keep the whole thing afloat.

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  • So true

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  • Agree totally. But the biggest issue is how do we stop seeing patients like this. I audited a week's worth of contacts. If you discount reassurance at least 50% of the patients were unaffected in terms of their outcome by seeing a doctor. Why would a taxpayer want to throw more money as a system like this? The money needs to be given to treatments where there are hard outcomes such as cataracts and hip replacements and cancer treatments. Granted we are very efficient but we are efficient at doing stuff that often doesn't matter.

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  • Mark Carri misses the point, the value of the GP is sifting the jumble of presenting symptoms, to decide what is the cause. Might be physical, psychological or social, each needs a plan of action to keep the patient a useful and active member of society.
    Saftey netting and review in case your plan of action fails.
    So far Google does not do this.

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  • I can well understand the pressure and frustration because as we all know the presentation of the same symptoms time after time does not mean that each patient has the same condition. However, there are occasions in certain aspects of medicine where GP's have particularly poor diagnostic knowledge but chose to take responsibility for triage, when other Primary Care clinicians exist, with much greater diagnostic skills, and are much more cost effective. MSK medicine is just one example. If GP's recognised and accepted the limitations of their medical knowledge and endorsed and worked in hand with pertinent diagnostic skill bases, they could facilitate greater time and effort to focus on the patients where their diagnostic skills relevant to their training paradigm best relate.

    Is the reluctance to move to accept the knowledge of others based on historic intransigence, egotistical arrogance, or a fear that the commissioners might realise that GP's are not indispensable?

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  • Now with the added game hazard of being sent to prison for manslaughter if we get anything wrong ever , we should probably let them get rid of us and tell everyone to go straight to hospital - It seems they are trying to cut down on surgery numbers so it is indeed the big idea to save all those expensive referrals and prescriptions ..

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  • 7.39 other healthcare professional (physio,osteopath,chiropracter?)
    The diagnostic skills relevant to our training paradigm,to requote your gobbledygook,is that the GP is required to assess those who are ill,or believe themselves to be ill (RCGP gobbledygook!) We simply have no idea what will come through the door next. If there is an art to general practice(and I am certain there is) then it is knowing what patient in that sea of uncertainty requires what intervention. If you want to "punt"for yourself to see an open access sea of MSK cases I congratulate you. Just be prepared for flood just like Noah. Better build a bigger Ark than the GP's have.

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  • I well understand the issues that confront a GP on a daily basis having once been one. However, having retrained I realise with frightening reality how flawed the training of GP's is as it relates to my now specialism of MSK medicine. The history taking is pitiful and the questions asked won't result in an appropriate diagnosis when a patient with an MSK condition presents. I just hope that such limitations are limited to MSK medicine.

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  • Paul, my intent was was not to offend or to personalise the issue. But with the greatest of respect if you are not even aware of the correct spelling of an associated professional what hope is there that you might have any knowledge of their expertise and thus consider consulting them to the benefit of your patient base. For clarity it is chiropractor not chiropracter. Your professional title might have given you a steer there doctor.

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  • Well written Dr Copperfield. Risk taking has become a hallmark of GPs. Not fight for GPs to be taking risks. For the patient as well as ourselves. We should become more investigation minded, for our patient's sake. Unless the percentage rate for correct diagnoses for every illness in the International DiseaseRegister is specified in our contract, or we are given a free hand, written in our contract, we should really investigate on a 100% rate of diagnosis basis.
    Retired GP.

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From: Copperfield

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