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My solution to secondary care workload dump

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The pledge to stop hospitals dumping work on GPs has made a big difference, hasn’t it? In the sense that it’s made the situation about ten times worse than it was before.  Specifically, the promise that consultants should make relevant onward referrals themselves rather than delegate the task to their default community houseman, aka me, which featured in the GP Forward View and was consolidated via a letter from NHS England sent to all hospital providers.

Then I started to sprinkle in some expletives

It’s almost as though consultants got wind of this and thought, oh yeah, dump on GPs, hadn’t thought of that, good idea, and clubbed together to buy a huge skip of excrement which they’re laughing about even as they watch it being tipped over us.

It’s not all bad, though. I’m actually rather enjoying composing letters which bounce back those bouncebacks. I started with the standard BMA template, which is authoritative and clear, but polite and long. Then I started to adapt it, using an increasingly abrupt and assertive tone which has now moved through abrasive to frankly aggressive. Then I started to sprinkle in some expletives, judiciously at first but now more liberally.

Astonishingly, none of the bounceback bouncebacks have bounced back and, even more astonishingly, none of the consultants have complained about them or me. There surely must come a tipping point where they will either alert the GMC or stop sending me this rubbish in the first place. And I’m trying to find it. Hence my most concise and refined version yet: ‘Dear Dr X, Re your attempt to delegate to me the onward referral of patient Y for Z. F**k the f**k off. Kind regards, Dr Copperfield. PS Dickhead.’

If that doesn’t work, I think I might pop over with a skip.

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

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Readers' comments (10)

  • Kiss my GP a$$ secondary care lol

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  • Forward the letter to the medical director of the trust and ask them to sort it out!
    - anonymous salaried!

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  • Priceless- thank you for cheering me up!

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  • Your attitude makes me despair for the medical profession.

    Firstly, you brought this on yourselves

    Remember it was you yourselves, who told everyone that you could do everything we did in secondary care only better and cheaper. Did you really not realise that this would make extra work for you all...

    Our CCG informed us in no uncertain, rather aggressive terms a couple of years ago that we were not allowed to make new patient referrals, and we would be fined for excess new to follow-up out patient slots. This was an inevitable consequence of that decision.

    Secondly, do you think you're the only ones who get dumped on? Here is a GP letter I received this morning in full 'This patient is under your care and I enclose a copy of the blood tests which are abnormal. Please advise'.

    I'm tempted to use one of your tactful template letters back. Dear GP - if you do the tests, its your job to work it out for yourself.

    Or I could do what I always do, which is to put the patient first. Something must have gone wrong in your heads with the attitude you express. Get help.

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  • Unfortunately it's the attitude of some doctors within both primary and secondary care that make things worse for everyone. But unclear boundaries help no one. And the time constraints and pressures we are under is leading to a system of just wanting to bounce people as soon as possible rather than look for a reason to help. And could you imagine a system where a GP might have good enough relations with their secondary care colleagues they could phone and say " re patient X I think you know would you be worried by these results" or a consultant could phone a GP and say "we want to get Mrs Y out of hospital soon but she will probably need follow up in 2-3 days can you squeeze her in?" Some of my trainers claim it used to exist.....

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  • The issue here is the crazy funding system. Hospitals have evolved into invoicing machines, billing like forensic accountants. The CCG's have no control over this, so instead they try to block patients from ever meeting a specialist, by blocking GP referrals, as well as internal referrals. We are all suffering!
    The plan? The 5y forward view push for "joined up" organisations. operating on controlled capitation budgets, rather than per item tariff.
    GPs have been strangled by capitation budgets for 10y, and are not jumping at the chance for managing even greater scope and demand within MCP type organisations while offering less autonomy to boot.
    Of course some practices are looking to merge, but usually because they realise they will lose the value of their practice buildings plus staff redundancy if they cannot recruit new GPs and then need to close down their business. They are simply desperate and choosing safety in numbers. The rest are watching anxiously.

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  • Anonymous | Sessional/Locum GP21 Nov 2016 1:13pm
    We have it locally - we use a system called 'Consultant Connect' to achieve it, and its had huge savings results.

    But, our practice has been aggressive at holding the acute to its contract and stopping consultants taking the p*ss, and its been very effective. I've even seen the odd apology.

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  • Anonymous | GP Partner21 Nov 2016 1:30pm
    Spot on. You can have any two of autonomy, democracy and integration, but not all three.

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  • Consultants are not deliberately 'taking the p***' nor is 'being aggressive' an acceptable response from the practice.

    We need to recognise are all working under huge pressure, without enough time or resources, and sometimes all of us fail to consider the impact of our behaviour on others.

    Some of the posters here need to use some consideration and mutual respect in their dealings with secondary care. Just because there isn't a national campaign to 'stop the workload dump' on us, doesn't mean it isn't there. The mountain we have to deal with on a daily basis doesn't need adding to with this kind of aggressive response.

    The BMA should be ashamed of those standard letters. They are absolutely appalling and if I ever got one, I would bin it for the sake of my blood pressure. Thankfully, the vast, vast majority of your colleagues wouldn't dream of sending anything so rude and unhelpful.

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  • I'm not sure that there is much corporate memory amongst our new rapid-progress SpRs turned consultants to even acknowledge such an idea as " you are now leaving the ward with an uncertain diagnosis/ complex treatment / uncertain likelihood of response to treatment, so come back to the ward / clinic next week" . It would be imappropriate to ask your GP ( on the way home / next week/ without a discharge summary to comment..." As SHOs we followed up and those who stayed in hospital practice learned from this monitoring...self-defeating now, isn't it?!

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From: Copperfield

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