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At the heart of general practice since 1960

There's no such thing as 'full' in general practice

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So, is it true? These rumours I’ve been hearing? I’ll find out sooner or later. Are you cheating on me or not?

Look, we’ve been in this together for so long. Years. And I’ve spent most of them banging on about how we GPs do a nigh-on impossible job nigh-on impeccably. About how, despite the micromanagement, the complaints, the guidelines, the impositions, the patients, the politicians, the policy wonks, the resource cutting, the media baiting, the constant change, the chronic headache, the continuous criticism, the doom, the gloom and the despondency, we GPs all sing from the same hymn-sheet, united on the front line, doing the best we can.

Then the rumours started. They may be just that, of course. But I’ve heard them repeatedly. All alleging the same thing.

This is what they’ve said: you, whoever you are, wherever you are, have been doing the dirty. Specifically, you’ve been arbitrarily declaring your day/surgeries/capacity for work ‘full’ and bouncing patients, whatever the problem, to A&E. Even worse than that, supposedly, some of you have given a standing order to your staff to do the deed for you. No wonder it’s currently A&E armageddon.

The first inkling was an email from our CCG asking practices not to divert patients to A&E when they can’t offer a same-day appointment, and to direct them to NHS 111 instead. True, as NHS 111 will refer them straight back to us, or A&E, this is hilarious. But the implication – that some of us are using A&E as primary care overflow – is less so.

Now, I don’t want to come over all holier than thou. But in the fortnight leading up to Christmas, and in the weeks since, my practice – besieged by the viral hordes – has regularly seen scores of extras each day.

Yes, we bitch about it. But we get on with it – it wouldn’t occur to us to do anything else, and certainly not to divert these patients to A&E. Not just because they’re obviously not sodding accidents or emergencies. Nor because they’d have to wait hours, suffer inappropriate tests and treatment, and be told to get us to refer them for their headache/sore throat/painful knee to neurologist/ENT surgeon/orthopod etc. Not even because every child who attends our local A&E, inexplicably, receives a free teddy bear.

No. We don’t do it because it’s wrong. There is no such thing as ‘full’ in general practice. And the moment we pretend there is, and use A&E to bail us out, we lose a lot of arguments about what makes GPs special. Besides, ‘full’ implies some definition of ‘capacity’, and that definition is open to manipulation. Imagine the fun our detractors could have with that, and the glee with which the Government would then try to set a minimum appointment provision per thousand patients.

Maybe those rumours are wrong. Maybe it’s all a silly misunderstanding. I bet most of you have been stoically working your butts off just like we have. But if there’s someone out there, right now, feeling guilty, let me tell you. It’s all over between us.

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

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Readers' comments (6)

  • I couldn't agree more, we need to do what's best for our patients and our NHS, yet on the other hand ensure that we are funded appropriately for bending over backwards to cope with the relentless demand. As a practice we have always offered same day appointments and walk ins. You need continuity of care and appropriate knowledge of your own patients to be able to educate them about self care. The government thinks having "conveyor belt" General practice is a cheaper option but we all know they know bugger all about general practice

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  • I think saintliness is great.

    I promise you the people you deal with do not have words such as 'right' and 'wrong' in their vocab.

    They will only deal with crisis, if you slave away and manage - they will respond by pushng you a little more.

    Primary care has limits, individuals have limits. when the line is crossed deal with it the best way you can and keep patients safe.

    I'm not a clinician any more. But if the choice is you go home at 2100 to see your kids and the patient goes to A&E or you go home at 2300 and you miss your family, I suggest you choose the first option.

    It may stick in your throat, better that and you live and keep trying your best. or you'll find yourself nearer your breaking point and if you survive dozens of your colleagues won't.

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  • AED received millions in winter pressure funding Primary Car received none, based on your idea David, we should never close, never say no. Why stop at AED surely diverting them to pharmacists and out of hours is immoral, we should see them all ourselves at any time. Incidentally look at the kings fund report ... AED attendances haven't gone up significantly, it's inefficient throughput that's the issue. Truly if you want to improve send them the viral hordes and spend your time looking after the elderly in the community and helping early discharge. Your practice is taking the easy way out, see all the viral URTIs and pretend you are performing some sort of public service when infact you may well be ignoring those who need the most help.. The elderly and the staff!

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  • And Tony is a partner of the old school GMS/PMS.
    What about profit led APMS - seen my scheduled 65 contacts - sod off the rest!

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  • I disagree, everyone has a limit and ultimately no doctor, be they gp, A&E doc or specialist needs to say no. Because sometimes my head, my life is full, and saying yes will be to the detriment of myself, my colleagues and my patients.

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  • There is only one thing that is full in general practice,it is the establishment and it full of s**t.

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From: Copperfield

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