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Independents' Day

'Send back to GP' has become a common refrain - but I understand why

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Can you imagine a world without the GP?  I only have to recollect the last 48 hours in practice to convince myself that the entire fabric of patient care in Britain would unravel if the death knell sounded for UK family doctors.

Take today, my on-call at what seems always to be the world’s busiest practice. 

At 9.03am, already running late (damn it), a practice note pings in: ‘Mr Jones has been discharged from hospital, his cannula’s still in and his daughter’s worried, can you ring?’

At 9.06am Delilah, 32, struggles in. She’s a single mum and is currently crippled by sciatica, wobbling on the upper rung of the analgesic ladder. The orthopaedic team cancelled her October appointment and she’s been re-scheduled for February. Through teary eyes, she begs me to expedite it. 

The practice notes start to come in thick and fast: the headache bloke doesn’t understand what neuro said, the patient referred to ENT’s not heard back from them, the psychiatric F2 needs a word.

Through all this, the consultations come and go: predictable, metronomic, numerous.

In pops the portly smoker in his fifties. And how would you describe the pain, sir? Well, bit like an elephant sitting on my chest. Excellent, give me a minute… Debbie, could you get an ambulance?

How many times in hospitals do you hear suggested, ‘send back to GP,’ or ‘the GP’ll sort it’? How often does the reassuring ‘see GP if concerns’ adorn discharge summaries? In A&E, where I enjoy a regular Wednesday shift, ‘GP’ can mean all sorts of things: referrer of rubbish, overpaid comfy-shoe wearing has-been, convenient but ignorant safety-net.  A nurse turned to me only last week, exasperated at the latest “crap referral” and said, ‘don’t you just hate GPs?’

So what if, post-apocalypse, there was no GP? Who would see the concerned, who would ‘sort it’, upon whom could some of our hospital colleagues unheap their charming clichés? 

But as I removed Mr Jones’ cannula late this morning, spent twenty minutes on the blower trying to get Delilah seen, and phoned the F2 back after explaining occipital neuralgia to the headache man, I realised, it couldn’t happen. We all need our GP. The GP is like home: familiar, dependable, stable, secure. When push comes to shove, we all go back. And when chaos reigns, there is no place like it.

Tom Gillham is a GP in Hertfordshire and Specialty Doctor in A&E. You can follow him @tjgillham.

Readers' comments (4)

  • And nothing has changed in 25 years............

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  • There is nothing to be gained from this kind of debate. We have all seen exemplary, poor, lazy and really helpful care at different times from both hospital doctors and GPs. No one can say this never happens in my patch. Please stop allowing the politicians to divide and rule, and learn some humility

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  • "See your GP" is the new goodbye

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  • So did you think the referral was "crap"?
    I agree with Anonymous 11.33 - we all have different roles, pressures, annoyances, and need maybe to spend time in other settings to see how things work before criticising. If an appointment's cancelled in secondary care, the doctor may have been ill, bereaved etc and the next available appt will be months away, thanks to the way the NHS is set up, there's no lack of willingness to see patients, just full clinics. Though inevitably the DNA's make us grit our teeth because we COULD have seen your sciatica lady if the DNA had been decent enough to let us know they weren't coming! And admin/typing support is cut to the bone so letters can take weeks to get to the top of the queue...

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