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Take out the 'gatekeepers' and watch the system collapse

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I’ve finally regained my power of speech only two days after reading the headline, ‘Patients to be allowed to self-refer for cancer diagnostics without going through GP’.

I won’t dwell on our reflex (but absolutely correct) concerns about overdiagnosis, overtreatment and overwhelmed outpatient departments – even though these problems suggest that this Bright New Idea is about as sensible as encouraging every cancer specialist to shoot him/herself in the head, which may indeed happen anyway.

What bothers me more is what it says about politicians’ view of the job we do, and the value they place on it.

Gatekeeping for cancer services is an incredibly difficult but necessary task combining science, art, experience and the twitching of the GP’s antennae. It’s impossible to do perfectly, but I’d defy anyone outside general practice to do it better.

But now, it seems, the Government wants to drive a coach and horses through it. Fine. But why stop there? If general practice really is such a redundant medical filter, why don’t I also dump in my waiting room a pile of sick notes for the work-shy and a trough of antibiotics for the sniffly snuffly masses?

Maybe the DH should remember what happened last time they pulled a stunt like this. Taking out-of-hours out of GP hands to be run by people not used to taking risks, living with uncertainty or saying ‘no’ – in other words, those who’ve never held a gate in their own hands – might have seemed like a good idea at the time.

But it wasn’t, as the ‘A&E like war-zone’-type headlines I’m reading today, again, would testify.

I’ve regained the power of speech. I just wish they’d lose theirs.

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

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Readers' comments (10)

  • Profound, prescient & perceptive as always.

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  • Those whom the gods wish to destroy they first make mad.

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  • Some lucky person is going to have the job of interpreting all those XRs / USS / CTs / MRIs / endoscopies / PSAs etc etc and explaining them to the patient. Now - I wonder who that special someone will be...............?

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  • Yes Michael, I posted a comment in the original article post about the 'fallout' from the system being foisted onto GPs. and like hell I would have anything to do with it.

    Let the system collapse I say, its obvious nothing we can do is going to mean anything, its obvious the GPC and RCGP are not going to help frontline GPs in anyway, with their 'warnings and letters'. Let the market eventually determine the worth of a GP - lets all go private!

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  • Eloquent,succinct and quite brilliant.

    Tony deserves his plaudits for excellent,witty and perceptive journalism.

    Used up all my adjectives but meant every word.

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  • As someone who works in an Imaging service in a tertiary unit, this ridiculous plan just makes me want to weep with frustration. Still, more opportunity to outsource diagnostics to the private centres I guess...

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  • I went to a ccg meeting---no interest from faceless or retired GPs doing their best to support their old practice --who like in the old pcg have become the richest GPs

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  • @ 2.22

    The old boys have done ok. Didn't stop the profession being destroyed as this was not in their self interest. Their mattresses are nicely stuffed full.

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  • Voted for self referral for oncology. Meant ONLY for patients who have had cancer and would self refer with the agreement of enlightened oncologists who realise the need for speed of diagnosis of metastatic cancers.

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  • Is this just another OMG moment when the whole Public health community jumps on another incorrect assumption....surely this is meant only for people with Cancer who need to kick on !

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From: Copperfield

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