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At the heart of general practice since 1960

It’s time to play the DH at its own game

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I took a certain smug satisfaction when the LMC and the BMA sent round template letters aimed at enabling GPs to ‘bounce’ inappropriate work back to secondary care. The obstinate part of me went all American: ‘Yeah! Woo-hoo!’ High-fives to GPs all round.

It is wrong that general practice has been expected to shoulder more and more extra work without additional funding. Yes, it is often it is easier for us to sort out medication or a sick note, but we no longer have the luxury of time and convenience has to play second fiddle to medical need.

Except I met a consultant surgeon this week. One of the nice ones. Happy to chat and engage with GPs. The conversation came round to letters and the large pile of them on his desk. I felt a little superior as I told him my own pile had shrunk.

He sighed: ‘I agree GPs were being asked to do work that wasn’t really their job. It’s just…’ I recognised the look of defeat all too well.

‘You see,’ he continued, ‘I no longer have a secretary – she cost too much, apparently. The hospital typing pool won’t do the letters. It’s a clinical issue, they say. I could ask medical records to pull all the notes but I’d have to sift through them before I could delegate.’

By now I was feeling less superior. ‘You’re surely not handling them all yourself?’

‘Yes,’ he nodded. ‘It just seems quicker. I spent all weekend doing them but there are still 80 on my desk.’

Cue an awkward pause. I must admit I felt a bit guilty. This is as much a waste of a highly qualified consultant’s time as it was of mine. Bouncing back the work wasn’t meant to make his life more miserable. It was to show the powers that be that general practice is at its limit. I had assumed that if consultants were faced with a deluge of work, they would kick up an almighty fuss and something would change. But it seems they are paid as little heed as us.

I still bounce the work back, but now I also send a silent apology to the consultants at the other end who haven’t yet found a way to bounce it on to where it really needs to go: to the door of NHS England and the Department of Health. I trust they will soon. The age-old hospital-GP rivalry is outdated and only benefits governments trying to divide and conquer. But it continues even now, as GPs hold the purse strings at CCGs, so it’s our fault if hospitals are underfunded.

I would rather put aside rivalries and work with consultants as a team. Maybe then we could play the DH at its own game. Unity is the one thing we’ve never had. But if we did, the medical profession would have the power to take on government threats and posturing.

Our practices are now expanding to include pharmacists and physician associates. Are we all part of the same team? We need to go back to basics, and remember that anyone working with our patients has to be part of our team. The goal is the same. The obstacles too. Why not consider Team NHS? Now, we just need an opponent. Hmm… Team Government seems up for this. Who would you bet on? Game on.

Dr Zoe Norris is a GP in Hull

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Readers' comments (20)

  • Great article, very thought provoking - thankyou!

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  • Are you volunteering for captain of Team NHS?

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  • Do we really hold the purse strings at the CCG? I doubt it.

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  • Well said Zoe, no need for the divide and conquer. our aims as GPs and secondary care clinicians are the same. Best to work together to fix them than throw stones (letters) at each other

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  • 'Silent apologies'! wont change anything Zoe.....make them VOCAL

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  • Vinci Ho

    I always believe the flag of NHS is independent , independent of any political party because politicians always want to step on NHS like a platform to boost their reputation . To uphold the flag , there is only one word: unity . Of course , people will say easy said than done but when we all have a common enemy right in front of us , this unity has become the only logical strategy.
    If GPs and consultants had ever treated each other like 'enemies' , this is the single critical time in our history to join force.
    Like I said about these stupid Labour MPs not knowing the rule of game of politics on the acceptance of their new leader: ally with your lesser enemy to raid your common enemy........

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  • Consultants can solve this by resigning on mass and offering their services back to the nhs and others as a chambers or limited partnership.
    At least as a GP I get to decide what work I can offload internally to administrators to make me work more efficiently.

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  • I felt so much better after sending back all the inappropriate work that was sent to me. However who loses? The patient.

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  • At what point will the hospitals have computerised notes?
    We are using SystmOne locally - and so are the care services e.g. physics, community nurses, community hospitals, and OOH are about to as well. The system is designed to work at different sites, and many hospitals already have portable computer trolleys on the wards as it is.
    I know it's a monopoly if the hospitals and GPs are all using the system, but it works and would make this kind of rubbish so much easier. I can't believe that in this day and age the consultants are still having to pull physical sets of notes, (except of course I can believe it). They are 20 years behind general practice, but why can't they join us, now the systems are in place?

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  • We are contending with a very powerful ruthless silky smooth and clever spin machine that at best is naive and at worst frankly evil. We haven't got s chance in matching it let alone overcoming it , because of our ingrained empathy and sympathy . I haven't got much hope.

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