Posted by: Tony Copperfield1 September 2016
I did enjoy the Guardian’s take on the BMA’s ‘Safe working in general practice’ document. Apparently, one of the reasons we’d like 15 minute appointments is because the population is increasingly overweight – and, yes, it is time-consuming jimmying them through the average consulting room door.
This idea is brilliant, elegant and potentially transformative. Oh, and utterly unworkable
Otherwise, though, the coverage was skull-bangingly exasperating, focusing, as it did, on the BMA’s call for GPs to have 15 minute appointments. After all, this simply gave an NHS spokesman the opportunity to say, ‘Durr, it’s up to GPs what appointment lengths they offer, dumbasses’, or words to that effect, thereby closing the story and ensuring the point was missed.
And that point is the fact that this is, of course, about workload, and therefore safety. Which the BMA did consider, at length, and proposes to solve with the use of locality hubs. This idea – to contractually define how many appointments GPs can reasonably be expected to cope with per day, and to divert any overspill to local multidisciplinary hubs – is brilliant, elegant and potentially transformative. Oh, and utterly unworkable. Here’s why:
1. Why would the Government agree to change a system which currently means they can dump as much faeculent matter on us, from an altitude of their choosing, at no cost, and at great amusement, to themselves?
2. Where would the funding come from? Answer: from us, rather defeating the object. And if not from us, then from some of the various illusory pots of money currently appearing like Pokemon Go characters – which, if it ever materialised, would merely be ‘pump-priming’ before the dosh is topsliced from some other budget intended for GPs. In other words, from us.
3. Who will staff these hubs? We will. Let’s think, now. That takes us out of our surgeries, thereby reducing workforce, thereby leaving fewer GPs to cope with the same demand, thereby busting the contractual requirement to have a sensible ceiling of consultations per GP per day, which was the original purpose of the scheme. Arse.
4. What’s to stop us gaming? No, we’d never do that. We never did it with health promotion clinics and we’ve never done it with QOF, obvs. But the temptation to bring back the odd patient for a totally unnecessary review, thereby blocking the few appointments I have remaining and enabling me to glide through surgery on autodoc might be overwhelming, and impossible to police.
5. What happens when the hub is full? The patients go to A&E? And what happens when A&E make the same contractual demands, and A&E is full? The patients, presumably, get sucked into a massive black hole, never to be seen again.
Because that, ultimately, is what all this is about. Patient demand is insatiable. Ideas like hubs are superficially attractive but simply shift the problem onto someone else, who can then make the same case. I don’t have any solution other than a population lobotomy to change illness behaviour. And, to be honest, the Government is more likely to accept that than what’s currently on the table.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield