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At the heart of general practice since 1960

Like lambs to the slaughter

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Cattle come in herds, right? And the correct word for rounding them up is herding, yes? So the sheep equivalent must be ‘flocking’. In which case, at the recent Pulse Live conference, there was a whole lot of flocking going on.

Normally, when you get a load of GPs together, the resulting noise is a cathartic whining. Not this time. All I heard was baa-ing: we were being led, sheep-like, towards a new vision of general practice. The many conference movers and shakers insisted that General Practice Must Change, and all those being moved and shaken nodded woolly nods.

To which I offer two words: ‘sore’ and ‘throat’. I saw one the other day. Unsurprisingly, it was viral pharyngitis. Our leaders would say that this trivial type of problem is something we GPs should no longer be dealing with. It should be self-helped or triaged away: we have bigger and better things to do. Hang on, though. That sore throat might just be tonsillitis, a quinsy, glandular fever, a retropharyngeal abscess, a foreign body, aphthous ulceration, candida, a serious ADR, GORD, glossopharyngeal neuralgia, carcinoma of the tonsil or leukaemia. And if it is ‘just’ viral, there’s illness behaviour and patient expectation to deal with – just the job for a GP, especially if it means blood on the carpet.

So a simple sore throat isn’t so simple after all – though you’d need to be a GP to figure that out, and in two minutes flat. Ditto ‘cystitis’, ‘thrush’, ‘piles’, ‘conjunctivitis’ and every other minor illness you care to slot into my surgery.

Besides, I like sore throats. Managing patients who are ill, or think they are, reflects the job description I signed up to and, unlike the treacle-wading of chronic disease management or primary prevention, is such fun it doesn’t make me want to stick forks in my eyes. Suddenly, though, my traditional role is under threat from a noctor and an algorithm, leaving me to be electron micromanaged through the Brave New GP stuff: commissioning, box-ticking, multimorbidity-monitoring and public sodding health.

To which I’d say two things. First, while I’m agitated about where we’re heading, I’m even more pissed off about where everyone thinks we’ve been: the implication that we can devolve our role so easily denigrates what we’ve been doing up until now. Our CCG doesn’t realise this. It assumes we’re just gagging to attend more commissioning meetings, for example. We’ll pay for your time, it says. Subtext: anyone can do your job, come and do some real work.

And, second, before the Great and Good deconstruct and revamp our day job, they should remind themselves what happened to our night one. Some bright spark thought out-of-hours care could be dismantled into something cheap and protocol-driven, remember? A resounding success.

I’d like to believe we realise this, that we won’t be lambs to the slaughter. But as things stand, the future vision of general practice can be summed up in another two words: flocking hell.

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From: Copperfield

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