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At the heart of general practice since 1960

Is no one else talking about the elephant in the room?

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Before I worked in a job I care enough about to it gives me sleepless nights, I used to work in a zoo. Although this might sound exciting, the reality was that I was responsible for cleaning the ball pit in the play area when one of the children found some ‘chocolate’ (the worst type being a Curly Wurly). 

Back then the only perk of the job was having lunch watching the beautiful elephants, in awe at their gentleness and grace despite their immense power. (Well, that and having a go on the death slide).

But now the elephant in the room is a much less tangible thing.

Much has been made of the past months about the crises in A&E and in general practice. Politicians have blamed GPs and GPs have blamed politicians. The media have blamed both, and patients don’t know who to blame. It’s not unreasonable to suggest that general practice is receiving the worst of all this crossfire.

In response to our ever-increasing workload, the BMA have released Quality First: Managing workload to deliver safe patient care. This provides, among other things, template letters to respond to inappropriate requests such as early sick notes or unreasonable prescription demands. And herein lies the trunk of the matter.

Sometimes, patients demand too much. I’ve only worked in general practice for about a year, but I already finish surgeries exasperated at the sense of entitlement some people seem to have of an underfunded and overstretched health service. I have had patients take a relative to A&E because they wouldn’t wait for me to see them at the end of my surgery as an extra patient. A young man threatened to phone for an ambulance because I would not advise him how to best perform surgery on himself.

Even he who must not be named took his children to A&E because he didn’t want (want, not need, being the operative word) to wait for a GP appointment. I don’t blame the public – they are told that they have a right to see a GP at a time of their choosing for any problem, big or small. The problem is, telling the electorate that you can probably can wait to see a GP, let alone stave off that trip to A&E, doesn’t win votes or sell newspapers.

So it’s easier to bash us and our secondary care colleagues, who appear to have a moral responsibility not to send people away (that and the fear of being sued). Sending a patient a stern letter from a template only serves to break down crucial relationships. This responsibility should lie higher up the food chain, not with front line staff who already have enough on their plate. After all. wasn’t this the reason the templates were released in the first place?

Of course this ‘elephant’ is much more complex than I could ever fathom, but it remains off the political agenda. Until this changes, it seems that the sacrifices made by all manner of healthcare staff to keep the NHS afloat in the face of unprecedented demand aren’t going to result in a pat on the back.

Mind you, with all this elephant talk, perhaps that’s not so bad after all. 

Dr Danny Chapman is a GPST3 in Exeter.

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Readers' comments (20)

  • Vinci Ho

    The difference between politicians and GPs , son, is the former has all the power to spin , interfere and impose all the time: they will not leave us alone. We are only fighting back as they 'blame' us first.
    Truth is only history will judge......

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  • bottom line - time to ditch NHS - it will end entitlement.

    in the real world you can have whatever you want as long as you pay for it.

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  • I have noticed so many people wanting the nhs to sort out things that would make life easier. People requesting antibiotics or even simple analgesia for going on holiday to save them money is only one I've recently come across. I also notice how people are telling me how they had to wait a few days fo an appointment so I should definitely be able to cure their cold.

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  • Welcome to the real world.Looks like these pups are finally growing up!

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  • What about GPs' unreasonable demands? Are you planning to tackle that issue in future blogs?

    Why is the focus (for an under resourced NHS) always on patient demands and never on GP demands?

    Wants vs needs and all that doesn't just apply to patients......

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  • Well said and well written.

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  • Vinci Ho

    "We Didn't Start The Fire" lyrics





    Well piece of article , son.
    Song for you
    Happy Chinese New Year of Goat( another colleague called it scapegoat on his comment)

    "We Didn't Start The Fire"
    Billy Joel

    Harry Truman, Doris Day, Red China, Johnnie Ray
    South Pacific, Walter Winchell, Joe DiMaggio
    Joe McCarthy, Richard Nixon, Studebaker, Television
    North Korea, South Korea, Marilyn Monroe

    Rosenbergs, H-Bomb, Sugar Ray, Panmunjom
    Brando, The King And I, and The Catcher In The Rye
    Eisenhower, Vaccine, England's got a new queen
    Marciano, Liberace, Santayana goodbye

    We didn't start the fire
    It was always burning
    Since the world's been turning
    We didn't start the fire
    No we didn't light it
    But we tried to fight it

    Joseph Stalin, Malenkov, Nasser and Prokofiev
    Rockefeller, Campanella, Communist Bloc
    Roy Cohn, Juan Peron, Toscanini, Dacron
    Dien Bien Phu Falls, Rock Around the Clock
    Einstein, James Dean, Brooklyn's got a winning team
    Davy Crockett, Peter Pan, Elvis Presley, Disneyland
    Bardot, Budapest, Alabama, Khrushchev
    Princess Grace, Peyton Place, Trouble in the Suez

    We didn't start the fire
    It was always burning
    Since the world's been turning
    We didn't start the fire
    No we didn't light it
    But we tried to fight it

    Little Rock, Pasternak, Mickey Mantle, Kerouac
    Sputnik, Chou En-Lai, Bridge On The River Kwai
    Lebanon, Charles de Gaulle, California baseball
    Starkweather, Homicide, Children of Thalidomide...

    Buddy Holly, Ben-Hur, Space Monkey, Mafia
    Hula Hoops, Castro, Edsel is a no-go
    U-2, Syngman Rhee, payola and Kennedy
    Chubby Checker, Psycho, Belgians in the Congo

    We didn't start the fire
    It was always burning
    Since the world's been turning
    We didn't start the fire
    No we didn't light it
    But we tried to fight it

    Hemingway, Eichmann, Stranger in a Strange Land
    Dylan, Berlin, Bay of Pigs invasion
    Lawrence of Arabia, British Beatlemania
    Ole Miss, John Glenn, Liston beats Patterson

    Pope Paul, Malcolm X, British Politician Sex
    J.F.K. blown away, what else do I have to say

    We didn't start the fire
    It was always burning
    Since the world's been turning
    We didn't start the fire
    No we didn't light it
    But we tried to fight it

    Birth control, Ho Chi Minh, Richard Nixon back again
    Moonshot, Woodstock, Watergate, punk rock
    Begin, Reagan, Palestine, Terror on the airline
    Ayatollah's in Iran, Russians in Afghanistan
    Wheel of Fortune, Sally Ride, heavy metal, suicide
    Foreign debts, homeless Vets, AIDS, Crack, Bernie Goetz
    Hypodermics on the shores, China's under martial law
    Rock and Roller Cola wars, I can't take it anymore

    We didn't start the fire
    It was always burning
    Since the world's been turning
    We didn't start the fire
    But when we are gone
    It will still burn on and on and on and on
    And on and on and on and on...

    We didn't start the fire
    It was always burning
    Since the world's been turning
    We didn't start the fire
    No we didn't light it
    But we tried to fight it

    We didn't start the fire
    It was always burning
    Since the world's been turning
    We didn't start the fire
    No, we didn't light it
    But we tried to fight it

    We didn't start the fire
    It was always burning
    Since the world's been turning
    We didn't start the fire
    No, we didn't light it
    But we tried to fight it

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  • Excellent article which sums up the issue incredibly well!!

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  • Cleaning up elephant doo dahs is more rewarding.why get involved in public bashing it's all been said thoussands of times

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  • Danny - I'd start planning your exit to Australia now. I finished my UK GP training a few years ago and like you became exasperated with the entitlement and abuse of the system that goes on. 10 minute appts and the amount of QOF we had to cram in to those 10 minutes was the final straw - I would often think 'is this what I went to medical school for?'. Since working over here I've regained self-respect, respect from patients, doubled my salary, and do interesting hands-on work. It's not complete GP paradise - but it's not far off....

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