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Independents' Day

Dear consultants, we are not your lackeys

Dr David Turner

Dr david turner duo 3x2

I’ve ranted about this before and I’ll rant about it until I’m blue in the face: GPs are not consultants’ junior doctors.

I’ll say it again: GPs are not there to do the job of your juniors and support staff.

Despite all the promises that GPs are no longer to be ‘dumped on’ by hospitals, like poverty and inept governments, it never stops.

If anything, the extent of hospital work dumping has grown. It ranges from the oblique reference, such as, ‘it would be helpful it this patient were to have some physiotherapy’, to the overt, in your face, unapologetic crapping of work on our desks – for instance, ‘GP to do bloods in three weeks , titrate up analgesia, refer to physio and if no improvement refer to pain clinic’. Perhaps you’d like me to paint the patient’s garden fence while I’m at it?

Some of this behaviour is downright dangerous

If it weren’t such an absolute salt irrigation of an anal fissure, some of the dumping would be funny.

Like when a specialist in the local hospital sees a patient, decides the problem is too complex for him/her and that it needs a referral to a tertiary centre to see a sub-specialist – and that the person best suited to referring to this sub- specialist is, you guessed it, the GP.

Some of this behaviour is down to arrogance, some laziness and some (although less than claimed) is due to budgetary constraints.

Whatever the reasons, however, some of it is just downright dangerous.

I attended a meeting recently where a consultant thought it entirely reasonable to ask GPs to prescribe unlicensed medications to children.

I raised this with the consultant, and asked if they realised we take full clinical responsibility for prescribing even if the drug has been recommended by a specialist. The reply was that it is cheaper for GPs to prescribe. To which the chair of the meeting, to his credit, pointed out an FP10 costs the same whether issued by hospital or general practice. That some consultants need this spelled out to them is worrying.

I have tried every tactic in the book to deal with secondary care dumping: ignoring it, getting angry, trying to reason with the consultants and becoming utterly miserable, until all that is left is acceptance. Well, that, and an angry blog.

Dr David Turner is a GP in north-west London

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Readers' comments (14)

  • Unfortunately the patient is dragged into this, and they tend to defer to the consultant, the patients regard us as subordinate to the expertise of the consultant. The NHS funding streams also fund Primary Care as subordinate to Secondary care. So in the face of this I guess we are their lackeys.

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  • Agree with BAP- GP's time is seen as a joke, and we are there to protect consultants from having to do boring things like referrals, follow ups and ordering bloods so they are free to order complicated scans and get away to their private patients in time.

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  • Please don't get upset. Just plain don't do it. . I have to ask the patients to go back to the hospital main reception and try to get this sorted there. It is between the consultant and their patient. It has nothing to do with us.

    I don't even write back anymore. I ask the admin to give their secretary a call back to inform them that i am sending the patient back. If the have an issue they can chase me and i will get back to them when i have a moment.

    My patients realise that i only refer for a specialist opinion when this something that i can't help further myself. They respect me and because we have mutual respect and relationship they will not allow me to be abused by anyone.

    The bma have useful templates to help guide decision making.

    - anonymous salaried!,

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  • "Some of this behaviour is down to arrogance, some laziness and some (although less than claimed) is due to budgetary constraints."

    And some is due to patient choice, with consultants unable to do this, at least that what our lot tell us (and explain to our patients!)

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  • The 'partialist' will see the GP's patient now.

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  • The GP is the hub of it all. Pity that our share of funding has halved in 13 years. But since we have an expanding Contract with no boundaries we are the cheapest/ least cost option.
    But this is the choice we make. We can and must change our Contract to activity based from capitation based. But almost all oppose this type of new Contract.
    If we continue to have one fee for everything, then everything just grows and GPs who cannot stomach this free for all, just go.
    If we do not change soon, the canoe tipping over moment is coming.

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  • AlanAlmond

    Neurologist ‘I saw your patient with epilepsy for the first time in 3 years. Their epilepsy is very badly controlled. You might like to try introducing drug x whilst simultaneously reducing drug y. Be careful because these 2 drugs interact so you might like to check their bloods 2 weekly and keep a close eye on them. If this doesn’t control their epilepsy you might like to try drug z. I’ve told them to come and see you for their new prescription and don’t intend on seeing them again without a new referral. Ta-ra. Prof ‘my-time-is-very-Important-yours-is-free-al-souf’

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  • My latest trick is to hand write on a copy of their letter
    - the date
    - message to say I am not doing the bloods/ prescribing the meds/doing the heart surgery etc
    - signature

    Then scan that bit of the letter back onto are system and post back to the consultant

    Found it was quicker than typing another letter

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  • Oops “our”

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  • The comments above are spot on - as is the article. This is surely one of the biggest problems facing general practice right now.

    I'm getting so fed up of consultant dumping and there seems to be nothing that can be done to stem the flow.

    Our spineless leaders need to stand up and do something, otherwise the whole profession is going to collapse before our very eyes. I've spoken to two fantastic GPs just this week who have either left or are leaving general practice to pursue other careers. Why is nobody doing anything about this?

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