Posted by: Tony Copperfield22 September 2016
Yes, I know, I’m a curmudgeonly old git who has only been prevented from putting ‘Life’s a piece of shit, when you look at it’ as a mission statement on my practice headed notepaper by a gratifyingly close vote during a recent practice meeting.
And I realise, too, that I’m particularly scathing about NICE guidance because, let’s face it, most of it is really is utter bollocks. So this might come as something of a surprise: I really like NICE’s latest effort.
Anyway, it’s good in all sorts of ways
It’s on multimorbidity and it’s actually quite good. No, seriously, it is, plus it carries with it the delicious irony that it’s been so long in the making – four years – that many of us GPs have actually developed some of those very multimorbidities it refers to in the interim. You know, psychosis, chronic pain, substance misuse etc.
Anyway, it’s good in all sorts of ways. It talks about reducing treatments and rationalising services that patients are attending. It emphasises quality of life rather than the dogged and moronic pursuit of quantity. It gives us permission to do this opportunistically rather than compelling us to be systematic, and it acknowledges pragmatism (eg frailty = being so slow to get the consulting room that I can pop out for a Hob Nob and a coffee while waiting and still be back before they’ve got the seat warm. My words, not theirs, but that’s what they mean).
And OK, yes, it talks about ‘care plans’ - and I know that phrase will make you vomit up that caffeine/biscuit slurry I just referred to – but it does so in the context of figuring out what is important to the patient and addressing the ‘What are we actually trying to achieve here?’ question.
So credit where it’s due. There is, of course, one teensy catch, as follows. The definition of multimorbidity is a patient with two or more long term conditions who either finds it all a bit of a faff or who we, the health service, find a bit of a faff (my words again). That strikes me as just about every elderly patient I see.
I would love to apply the guidance to them – it genuinely would do me, them and the NHS a lot of good – but to do so would take about an hour for each, and one hour multiplied by a vast number = not guidance, but a new job description.
Which means one thing is missing here. NICE has bucked the trend by condoning the stopping of drugs. Now, to fulfil our new role of community general physician, we just need some other authoritative body to condone stopping something else. Specifically, all our other work.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield