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At the heart of general practice since 1960

The sins of the barking few

Copperfield is outraged at facing a referrals squeeze thanks to a bonkers minority.

Copperfield is outraged at facing a referrals squeeze thanks to a bonkers minority.



I normally reassure those who worry about the future by pointing out that the earliest it could happen is tomorrow, and as that never comes, we can all relax. Bugger me, though, if it hasn't just arrived. It's sitting on my desk right now. And, if the future of rock and roll is, or was, Bruce Springsteen, then the future of general practice looks like the Tweets singing the Birdy Song. That is, it appears limited, soulless and likely to trigger anything from emesis through to mass suicide.

Because I'm looking at Service restrictions for GPs – the shape of things to come. And at first glance, that shape is dark and ominous.

Here are some clinical areas my PCT won't fund unless ‘there is proven clinical exceptionality': treatment of CFS/ME, allergic disorders and people with gender dysphoria.

Yes, I can understand the logic, but no, I'm not looking forward to squeezing sleepy, sneezy and genitally grumpy – or, indeed, any of the seven dwarfs – into 10-minute appointments.

There's more. I can no longer refer patients for Borboth therapy or rhytidectomy. This is terrible. Not because of the service restriction, but because my patients haven't even had the opportunity to be inappropriately referred yet, since I've no idea what these treatments are.

Acromegaly I've heard of, though. For some reason, that's on the list of restrictions too. Presumably this means that, under certain circumstances, I've got to say ‘no' to acromegalics. Appalling. Hasn't the PCT seen the size of these people?

Most perplexing, though, are restrictions on gallstone surgery and joint replacements. Why target those with crippling bellyache or arthritis?

A Pavlovian reflex involving ears and steam has me reluctantly flicking from the A4 laminated summary to the 80-page policy document. Hang on. I can refer gallstones, after all. It's just asymptomatic gallstones that won't be funded. And sure, I can refer crumbly knees and hips, too – as long as the pain is significant and unresponsive to the usual analgesia/physio/ flab-fighting combo.

So I relax. Until the penny drops. Then I stiffen and start frothing again. Because, either the PCT thinks I am capable of referrals of such monumental stupidity as asymptomatic gallstones or insignificant arthritis – in which case, thanks a bunch for implying I have the brain of an axolotl.

Or there already exists a minority of GPs out there making these bonkers referrals – which begs two questions. One, what the f*** are they doing? And two, what is the point of the annual ritual of worthy educational hand-wringing known as ‘appraisal', if not to pick up such aberrant, wasteful behaviour?

Clearly, the process isn't working. And the result is the sane majority of GPs like us end up paying for the sins of the barking few, by having to pick the bones out of massive, forbidding policy documents to discover we've been doing it right all along.

'Sick Notes' by Dr Tony Copperfield is out now, available from Monday Books.

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