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GPs go forth

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)

  • Correction. Not right for GPs,instead of fight for GPs.

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  • @7.39.... I take your point and would be the first one to agree that patients would be better off seeing another healthcare professional and I actively encourage that such professionals have more expertise in say treating say mechanical back pain (while we are discussing msk issues) but disagree with you that " GPs have chosen to take this on in triage" I would be more than happy if another healthcare professional would do the triage and take the risk.. ( if there was a sinister cause )

    But with many things it comes down funding. We used to have a in house physio who was amazing for our msk complaints but funding was withdrawn and was gone with the wind ... What's the alternative now, well a 2-3month wait for hospital physio triages over phone sends some leaflets and most cases patient dissatisfaction at minimal time spent.

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  • Thanks for your comments in relation to MSK professionals. For context we have had an NHS contract as a chiropractic clinic for 7 years. We have 98% patient satisfaction from PROM. We have been proven to be more cost effective than the previous system. However, since the dissolution of PCT's there has been an introduction of an inefficient MSK Triage run by GPWSI, who respectfully have insufficient knowledge. Referral times have altered from less than 5 days to 16 weeks. In relation to diagnostic ability for red flag issues I would suggest one speaks to a chiropractor to understand the knowledge we have in this area. When this is understood and adopted universally the pressure on GPs will reduce and the cost to the NHS and the patient commensurately. It is very concerning the costs incurred for MRI and nerve conduction tests that a simple 30 second orthopaedic test would confirm a diagnosis. Respect allied professionals and use them appropriately and the burden at the GP door will diminish exponentially.

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  • As I stated it all comes down to funding and the area you are in and who makes the decisions and the politics behind it, we don't volunteer ourselves for extra work...we wanted to keep our physio and chiro isn't available in our comming time this may be the least of our worries with NHS cuts and saving our surgery may be on the agenda . Respect is a common courtesy and we shouldn't let our views of judgements impair this. I recently saw a private physio who very swift in commenting how his GP spent little time with him and we should see a set number of patients a day (laughable) and good GPs run late as they listen to their patients... Ironically my 30mins were up and I needed to rebook as the next private client arrived.

    PS . The comment about the numerous tests opens the medico-legal reasons / art vs science discussion one for another day!

    All the best

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  • Patients must be given some RESPONSIBILITY over their health.Following your assesment, which must includes a clinical examination and not just a few questions from behind a computer screen, they must be told
    1.If you get worse come back immediately
    2.If there is no improvement at the end of the course of treatment(which could be bed rest and paracetamol or antibiotic course or physio etc.) please return
    3. If symptoms persist for a couple of weeks please return
    It is then over to the patient and the GP cannot really be faulted.

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  • The issue about doing nothing is not new, nor confined to the NHS. The Orthopaedic consultant I worked for in 1982 told the story of the lady he saw privately, and sent a bill for 10 guineas (yes, it was a long time ago!). The patient sent the bill back and said it was ridiculous as he had done nothing. So he sent a further bill to her which said: For doing nothing, no charge. For knowing nothing needs doing, 10 Guineas.

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  • Reply to anonymous other health care practitioner revealed as chiropractor.
    My apologies for my spelling and I regularly defer and refer to my colleagues in physiotherapy and osteopathy both private and NHS. My point is that I suspect that your patients are a mix of self and GP referral. If you want to be first point of contact for every problem perceived by the patient to be MSK related, as far as I am concerned you are welcome. I just reckon you will be swamped.
    In my last practice each partner enjoyed expertise in something different and we encouraged each other and our staff to direct the patients to the "skin doctor" MSK doctor etc. I would love to be really good at everything but to quote a not very good medical joke.
    The specialist learns more and more about less and less. The GP learns less and less about more and more. The specialist will soon know everything about nothing and the GP everything about nothing.
    I wish you well.

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From: Copperfield

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